NMA: Nonprescription Medicines Academy

Risk of Acute Kidney Injury in Adults Increases with Two Antihypertensive Agents Plus NSAID

April 17th, 2013

Triple therapy with (1) a diuretic, (2) an angiotensin converting–enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB), and (3) a nonsteroidal anti-inflammatory drug (NSAID) may increase the risk of acute kidney injury, based on the results of a retrospective, nested case-control analysis conducted in the United Kingdom.

The analysis used data from the Clinical Practice Research Datalink linked to the Hospital Episodes Statistics database. The authors assembled a cohort of 487,372 patients who received antihypertensive drugs between January 1, 1997, and December 31, 2008, with follow-up through December 31, 2010. Cohort entry date for the study was the date of first prescription for any antihypertensive drug (diuretics, ACE inhibitors, ARBs, calcium channel blockers, α and β blockers). Patients were followed until a first-ever hospital admission for acute kidney injury, death from any cause, or occurrence of a study exclusion. The main outcome measure was acute kidney injury associated with current use of double therapy (NSAID plus a diuretic, ACE inhibitor, or ARB) or triple therapy (NSAID plus diuretic plus ACE inhibitor or ARB).

A total of 2,215 cases of acute kidney injury were identified during a mean follow-up of 5.9 ± 3.4 years (incidence rate 7 per 10,000 person years). Overall, current use of double therapy was not associated with an increased rate of acute kidney injury. In contrast, current use of triple therapy was associated with an overall 31% higher risk (rate ratio 1.31; 95% CI, 1.12–1.53), driven by a nearly twofold increased risk in the first 30 days of use (rate ratio 1.82; 95% CI, 1.35–2.46).

BMJ. 2013;346:e852.