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Triple therapy with antihypertensives and NSAIDs linked to acute kidney injury

19 Apr, 13 | by kuppell

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.

 

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