Sugar was on Metacam for about three years for her arthritis. It was the only NASID my vet wanted to use because she also had heart disease. She did die of kidney failure, at 12 1/2, but this was after 2+ yrs on Enalipril and Lasix, and a year on Vetmedin, which is known to be hard on the kidneys. She had actually been off Metacam for about 6-8 months, at the end. It seems to be as safe as any NASID for long term use, for most dogs. Definitely get regular blood tests.