Even Light Drinking Harms Kidneys with Acetaminophen

Acetaminophen can significantly increase the risk of kidney dysfunction when paired with even light or moderate alcohol consumption, according to new research presented November 4 at the American Public Health Association’s 141st Annual Meeting in Boston.

Lead author Harrison Ndetan, MSc, MPH, DrPH, believes these findings should encourage physicians to begin questioning patients about acetaminophen intake any time they come across unexplained, slightly abnormal kidney function tests, such as glomerular filtration rate, serum creatinine, blood urea nitrogen, and proteinuria.

“This would enable them to recommend cessation of acetaminophen ingestion and so prevent the development of severe (acute/chronic or end-stage) renal disease,” says Ndetan, an associate professor of biostatistics/research at Parker University in Dallas, Texas.

He and his colleagues explored the effect of light/moderate alcohol consumption in combination with therapeutic doses of acetaminophen on kidney function. For the purpose of this analysis, they considered light/moderate alcohol consumption to be 1 drink (if female) or 2 drinks (if male), and defined the therapeutic dose of acetaminophen as less than 1.2g.

They analyzed data from more than 10,000 participants who responded to the 2003-04 National Health and Nutrition Examination Survey, which included questions about alcohol consumption, use of acetaminophen, and health conditions. Of these, 2.6% of respondents reported taking a therapeutic amount of acetaminophen in combination with light/moderate alcohol consumption—and 1.2% of them reported renal dysfunction.

Study results indicated that taking a therapeutic amount of acetaminophen or indulging in light-to-moderate drinking did not pose a particularly great risk to a patient’s kidneys.

However, when these two were combined, the researchers saw a 123% increase in the risk of kidney dysfunction. While more in-depth study is needed to identify particular subsets of patients who may be at greatest risk, Ndetan hypothesizes that the effects will be particularly pronounced among patients who are predisposed to acetaminophen or alcohol toxicity.

“This may include people with certain health conditions, such as AIDS, obesity, diabetes, hypertension, etc; those with certain dietary habits like starving (or fasting); as well as genetically predisposed individuals,” he says.

There are still many unanswered questions that he and his colleagues would like to explore. For instance, is there a critical dose or minimum duration of exposure to acetaminophen and alcohol associated with this problem?

“The result we have today is still very preliminary and suffers from suspect reliability since it comes from secondary data analysis,” Ndetan says. “It would be important to predict a threshold of a kidney function test result that would be a definition for ‘early’ kidney toxicity—which would have a huge potential of addressing prevention.”

—Colleen Mullarkey