Triple therapy combination consisting of diuretics with angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) and NSAIDs is associated with an increased risk of acute kidney injury according to a UK study.

In a retrospective cohort study researchers assessed whether double therapy consisting of a diuretic or an ACE inhibitor or an ARB with the addition of a NSAID, and triple therapy consisting of a diuretic plus an ACE inhibitor or an ARB in addition to a NSAID increased the risk of acute kidney injury. A total of 487 372 people using antihypertensive drugs between 1 January 1997 and 31 December 2008 were identified from the UK Clinical Practice Research Datalink (CPRD). Reporting their finding in the British Medical Journal the researchers say that during a mean follow-up of 5.9 years, 2215 cases of acute kidney injury were identified (incidence rate 7/10 000 person years). ‘Current use of a triple therapy combination was associated with an increased rate of acute kidney injury (rate ratio 1.31, 95% confidence interval 1.12 to 1.53). In secondary analyses, the highest risk was observed in the first 30 days of use (rate ratio 1.82, 1.35 to 2.46),’ say the researchers. However, double therapy combination was not associated with an increased rate of acute kidney injury.

The researchers say that, to their knowledge, it is the first large population based study of patients using antihypertensive drugs to have investigated the association between the use of different combinations of antihypertensive drugs with NSAIDs on the risk of acute kidney injury. ‘Increased vigilance may be warranted when diuretics and ACE inhibitors or ARBs are used concurrently with NSAIDs. In particular, major attention should be paid early in the course of treatment, and a more appropriate use and choice among the available anti-inflammatory or analgesic drugs could therefore be applied in clinical practice,’ they suggest. BMJ 2013;346:e8525.

In a new initiative for the journal, EJHP is now publishing podcasts. The first set were recorded at the 18^th EAHP Congress in Paris, and include a selection of interviews with speakers from the Congress. In an introductory podcast Phil Wiffen, editor in chief of EJHP, explains the thinking behind the podcasts, outlines the direction the journal is heading in and encourages those thinking of writing for the Journal to contact him.

One of the keynotes at the Congress, on the topic of multidisciplinary teams, was given by Dr Fiona Reynolds (pediatric intensivist and deputy chief medical officer at Birmingham Children’s Hospital) and in a podcast interview she discusses how a multidisciplinary team can be set up, how it can work in practice and what benefits it can bring to hospital pharmacy. In another podcast Joanna Correa West, medicines management nurse from Birmingham Children’s Hospital Foundation Trust considers how hospital pharmacists and nurses can work better together and ways in which they can help and support each other.

Following on from their seminar at the Congress entitled ‘Team challenges in cancer: from cytotoxics to supportive care’ Jørn Herrstedt, professor in clinical oncology, Odense University Hospital, Denmark, and João Oliveira, medical director, Instituto Portugues de Oncologia, Lisbon, share their thoughts about oncology pharmacy, improving patient safety and the role pharmacists can have in supportive care. Medication errors occur in all health settings, but there is particular vulnerability at the interface between care settings, especially at the time of admission to hospital. In an interview Jean-Hughes Dalle (professor in pediatrics, Robert-Debré Hospital, Paris) Julie Rouprêt-Serzec (clinical pharmacist, Robert-Debré Hospital) and Anthony Sinclair (director of pharmacy, Birmingham Children’s Hospital) share their thoughts  about how to improve patient safety in this area.