To the Editor In their recently published Original Investigation, Bouck and colleagues1 reported their findings about the prescription of nonsteroidal anti-inflammatory drugs (NSAIDs) after a musculoskeletal-related primary care visit by patients with hypertension, heart failure, or chronic kidney disease (CKD). We believe caution is warranted in concluding that there is no association between NSAID use and renal complications based on our own experience working with these same data sets held at ICES.