Use of triple therapy comprising diuretics and angiotensin converting enzyme inhibitors, or angiotensin receptor blockers, together with nonsteroidal anti-inflammatory drugs (NSAIDs) is associated with an increased risk of acute kidney injury (AKI), particularly in the first 30 days of treatment, according to a study published online in the British Medical Journal.
Francesco Lapi, PhD, of the Jewish General Hospital in Montreal, and colleagues conducted a nested case-control analysis to examine whether a double therapy combination (diuretics, angiotensin converting enzyme inhibitors, or angiotensin receptor blockers plus NSAIDs) or triple therapy (diuretics with angiotensin converting enzyme inhibitors or angiotensin receptor blockers, plus NSAIDs) correlated with the risk of AKI in a cohort of 487,372 antihypertensive drug users.
During a mean follow-up of 5.9 years, the researchers identified 2,215 cases of AKI. Overall, they found no increased risk of AKI with current use of a double therapy combination. However, current use of a triple regimen significantly increased the risk of AKI by 31%. The highest risk was seen in the first 30 days of use.
“Given that NSAIDs are widely used … and that a greater incidence rate of acute kidney injury was estimated among antihypertensive drugs users than in the general population, increased vigilance may be warranted when diuretics and angiotensin converting enzyme inhibitors or angiotensin receptor blockers are used concurrently with NSAIDs,” the researchers wrote.
Two authors disclosed financial ties to the pharmaceutical industry.