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08-01-2013 | General practice | Article

Drug combo kidney damage warning

Abstract

BMJ 2013; 346: e8525

medwireNews: Researchers have found that patients who take dual antihypertensive combination therapy at the same time as non-steroidal anti-inflammatory drugs (NSAIDs) are at considerably increased risk of kidney damage.

Using general practice data from the Clinical Practice Research Datalink, linked to the Hospital Episodes Statistics database, the team identified 2,215 cases of acute kidney injury among 487,372 antihypertensive users.

Analysis revealed that patients using diuretics and ACE inhibitors or angiotensin receptor blockers (ARBs) in combination with NSAIDs had a 31% increased risk of acute kidney injury - mainly down to a nearly twofold increased risk in the first 30 days of use.

Users of antihypertensive monotherapy in combination with NSAIDs did not have a significantly increased risk, however.

Writing in the BMJ, Dr Samy Suissa (McGill University, Montreal) and team conclude: "Although antihypertensive drugs have cardiovascular benefits, vigilance may be warranted when they are used concurrently with NSAIDs."

They add: "In particular, major attention should be paid early in the course of treatment, [so that] a more appropriate choice among the available anti-inflammatory or analgesic drugs could therefore be applied."

Drs Dorothea Nitsch and Laurie Tomlinson (London School of Hygiene and Tropical Medicine) write in a related editorial that the study "probably underestimates the true burden of drug associated acute kidney injury"; they urge clinicians to warn patients being prescribed diuretics and ACE inhibitors or ARBs about the risks of NSAID use.

medwireNews is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013

By Caroline Price, Senior medwireNews Reporter