Analgesic nephropathy caffeine + aspirin

As up to 10% of about 42 000 dialysis patients have suffered from renal insufficiency due to analgesic nephropathy (in the postphenacetin era), German nephrologists have demanded that medications that contain fixed combinations of analgesics (paracetamol, aspirin, or propyphenazone plus caffeine) be withdrawn from the market, following the example of their US colleagues in the National Kidney Foundation (27). 

In Belgium, the distribution of analgesic nephropathy in patients with terminal renal insufficiency was well correlated with the sale of drugs containing either aspirin -I- phenacetin or paracetamol + caffeine (SEDA-7,75), and it is estimated that Belgium, after Australia, had the second highest incidence of analgesic nephropathy in the world. 

Prevention has depended primarily on pnblic health efforts to restrict the sale of phenacetin and combination analgesics. This has effectively rednced analgesic nephropathy in Anstralia and Europe. However, risk continues with continued availability of OTC combination analgesics containing aspirin, acetaminophen, and caffeine in the United States and thronghont the world. 

Figure 2, Analgesic nephropathy is caused by abuse of analgesic mixtures plus caffeine/codeine. Left the potentiating effect of aspirin with both phenacetin and acetaminophen (see text). Adapted from [5, 9], with permission.

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