Short-term IV flurbiprofen axetil post-TKA does not increase renal injury in hypertensive patientsShort-term IV flurbiprofen axetil safe for kidney in well-controlled hypertensive knee surgery patients

Frontiers in Medicine Published April 24, 2026 DOI ↗ Editorial oversight: Dr. Julia Lee, PhD · Oncology, Genomics & Drug Development

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Key Takeaway

Consider that short-term IV flurbiprofen axetil post-TKA may not increase AKI risk in well-controlled hypertensive patients.

This prospective multicenter cohort study enrolled 120 patients who had undergone total knee replacement surgery (TKA) at four major hospitals. The primary exposure was short-term intravenous flurbiprofen axetil (FA) postoperatively, with a comparator group of normotensive patients implied within the cohort analysis.

The main renal outcomes—blood urea nitrogen, serum creatine, and Cystatin C levels—showed no statistically significant main effects of group, time, or group-by-time interaction (all P > 0.05). Urine N-acetyl-beta-glucosaminidase (NAG) levels were significantly higher on postoperative day 2 (POD2) and POD5 in both groups versus baseline (all P < 0.001). In the well-controlled hypertensive group, NAG levels continued to increase on POD5 (P = 0.039).

Acute kidney injury (AKI) incidence was 7.0% (4/57) in the well-controlled hypertensive group and 3.2% (2/63) in the normotensive group (P = 0.335). After adjustment, hypertension had no impact on AKI (OR = 0.733; 95%CI: 0.074–7.222, P = 0.790). FA significantly reduced pain intensity in both groups, with no significant differences in other complications.

All AKI cases were stage 1. The study did not report serious adverse events, discontinuations, or detailed tolerability data. Key limitations include the observational design, which precludes causal inference, and the focus on well-controlled hypertensive patients, limiting generalizability.

Practice relevance is restrained: the FA regimen appears effective for pain without increasing AKI incidence in this specific population, though the risk of tubular damage was noted as a consideration.

A study looked at patients who had total knee replacement surgery and received short-term intravenous flurbiprofen axetil (FA). The researchers included 120 patients from four major hospitals, comparing those with well-controlled hypertension to those with normal blood pressure. They tracked kidney injury markers and pain levels on postoperative days 2 and 5.

The study found that FA significantly reduced pain in both groups. While kidney injury markers like urine N-acetyl-beta-glucosaminidase levels rose in both groups after surgery, the incidence of acute kidney injury was low and similar between the two groups. Adjusting for other factors, high blood pressure did not increase the risk of kidney injury.

Other complications did not differ significantly between the groups. Although the drug poses a potential risk of tubular damage, this specific short-term use did not lead to more kidney problems in patients whose blood pressure was well-controlled. Readers should note that this was a small cohort study, so results may need confirmation in larger trials.

What this means for you:

Short-term IV flurbiprofen axetil reduced pain without increasing kidney injury risk in well-controlled hypertensive patients after knee surgery.

Study Details

Study typeCohort

EvidenceLevel 3

PublishedApr 2026

View Original Abstract ↓

BackgroundCurrently, 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.MethodsData 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.ResultsA 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.ConclusionThe 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.

Short-term IV flurbiprofen axetil post-TKA does not increase renal injury in hypertensive patientsShort-term IV flurbiprofen axetil safe for kidney in well-controlled hypertensive knee surgery patients

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Short-term IV flurbiprofen axetil post-TKA does not increase renal injury in hypertensive patientsShort-term IV flurbiprofen axetil safe for kidney in well-controlled hypertensive knee surgery patients

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