Study: Perioperative pregabalin reduces risk of kidney decline compared to gabapentin

Editor's Note

The first study to directly compare kidney-related adverse outcomes between perioperative use of gabapentin and pregabalin shows that the former drug carries a higher risk, Renal and Urology News reported January 21.

Published in Frontiers in Medicine, the study involved a trial emulation of 1,280 propensity-matched surgical patients in South Korea. Those initiating gabapentin had a 1.4-fold increased risk of a 40% or greater decline in estimated glomerular filtration rate (eGFR) within six months compared to pregabalin users, the outlet reports. The incidence of kidney function decline per 100 person-years was higher in the gabapentin group (9.70) than in the pregabalin group (8.20). Among patients without pre-existing chronic kidney disease (CKD), gabapentin initiation was associated with a 46% increased risk of new-onset CKD. Specifically, CKD developed in 10.21 gabapentin users versus 7.88 pregabalin users per 100 person-years.

According to the article, both groups showed similar rates of in-hospital acute kidney injury and mortality. The study excluded patients with end-stage kidney disease (eGFR < 15 mL/min/1.73 m²). Researchers emphasized that while gabapentinoids are commonly used to reduce opioid consumption, their differing pharmacokinetics may influence kidney outcomes. Gabapentin is entirely excreted by the kidneys, whereas pregabalin undergoes partial non-renal clearance.