What question did this study set out to answer?

This study aims to evaluate the renal safety of short-term flurbiprofen axetil use in well-controlled hypertensive patients after total knee replacement.

April 26, 2026Frontiers in Pharmacology0 citationsOpen Access

Renal safety of postoperative short-term use of flurbiprofen axetil in well-controlled hypertensive patients: a prospective multicenter cohort study

LSLiang Sun YJY Jiang XMXiaoran Ma

Key Points

This study aims to evaluate the renal safety of short-term flurbiprofen axetil use in well-controlled hypertensive patients after total knee replacement.
Multicenter cohort study conducted from January 2020 to March 2021 at four hospitals

Structured PICO

Does short-term postoperative use of flurbiprofen axetil increase the risk of acute kidney injury or renal biomarker elevation in well-controlled hypertensive patients compared to normotensive patients?

Population

120 patients undergoing unilateral total knee replacement surgery (TKA) under spinal anesthesia, ASA status I-III, divided into well-controlled hypertensive (n=57) and normotensive (n=63) groups.

Intervention

Flurbiprofen axetil 100 mg intravenous 30 min before the end of operation, followed by continuous intravenous infusion at 4 mg/h for 50 h (total 400 mg) in well-controlled hypertensive patients.

Comparator

Normotensive patients receiving the exact same flurbiprofen axetil regimen.

Outcome

Trajectory changes of postoperative renal injury biomarkers (blood urea nitrogen, serum creatinine, cystatin C, and urine N-acetyl-beta-glucosaminidase) on postoperative day 2 and 5.safety

Short-term postoperative use of flurbiprofen axetil does not increase the incidence of acute kidney injury in well-controlled hypertensive patients undergoing total knee arthroplasty, though it may pose a transient risk of tubular damage.

Abstract

Background Currently, postoperative nonsteroidal anti-inflammatory drugs-associated kidney damage in hypertensive patients remains undetermined. This study aimed to examine renal safety of short-term post-surgery use of flurbiprofen axetil (FA) in well-controlled hypertensive patients. Methods Data were collected from January 2020 to March 2021 at four major hospitals on patients who had undergone total knee replacement surgery (TKA). Patients were divided into well-controlled hypertensive and normotensive groups, and received short-term intravenous FA postoperatively. The primary outcomes were trajectory changes of postoperative renal injury biomarkers. Second outcomes included acute kidney injury (AKI), pain intensity and other complications. Results A total of 120 patients were enrolled. Post-surgery FA significantly reduced pain in both groups. The results of repeated measures analysis of variance (ANOVA) demonstrated that the main effects of group, time and the group-by-time interaction on blood urea nitrogen (BUN), serum creatine (SCr) and Cystatin C (Cys C) levels were not statistically significant on postoperative day 2 and 5 (POD2 and POD5) (all P 0.05). Urine N-acetyl-beta-glucosaminidase (NAG) levels were significantly higher on POD2 and POD5 in both groups preoperative: (6.66 ± 4.87) U/L, POD2: (10.07 ± 6.88) U/L, POD5: (10.25 ± 7.68) U/L in normotensive group; preoperative: (7.39 ± 4.07) U/L, POD2: (12.34 ± 7.1) U/L, POD5: (15.57 ± 12.34) U/L in well-controlled hypertensive group; all P 0.001 compared with baseline. However, only the well-controlled hypertensive group showed a continued increase in NAG levels on POD5 (P = 0.039). AKI occurred in 7.0% (4/57) and 3.2% (2/63) of well-controlled hypertensive and normotensive patients (P = 0.335), and all the AKI patients were at stage 1. After adjusting for confounding factors, hypertension had no impact on AKI (OR = 0.733, 95%CI: 0.074–7.222, P = 0.790). No significant differences in other complications were observed between the groups. Conclusion The current FA regimen after surgery is effective, and it does not increase AKI incidence in well-controlled hypertensive TKA patients, thought posing a risk of tubular damage.

问 AI

Bookmark

View Full Paper