January 10th, 2013
Acute Kidney Injury Associated With Dual Antihypertensive Therapy And NSAIDs
Adding a non-steroidal anti-inflammatory drug (NSAID) to dual antihypertensive therapy (a diuretic plus either an ACE inhibitor or an angiotensin receptor blocker) is associated with an increase in risk for kidney injury, according to a large new retrospective study published in BMJ.
Analyzing data from nearly half a million people taking antihypertensive drugs, researchers found 2,215 cases of acute kidney injury after a mean followup of 5.9 years. People on dual therapy were not at increased risk for acute kidney injury. However, when NSAID use was added to dual therapy, there was a modest but significant increase in risk (rate ratio 1.31, CI 1.12- 1.53). The increase in risk was highest in the first month of treatment.
The authors concluded that “increased vigilance may be warranted when” NSAIDs are used with dual antihypertensive therapy, especially in the early treatment period.
In an accompanying editorial, Dorothea Nitsch and Laurie A Tomlinson write that the safety of dual therapy still remains to be demonstrated and that the study likely “underestimates the true burden of drug associated acute kidney injury” in patients taking antihypertensive therapy and NSAIDs. Physicians should inform patients taking antihypertensive therapy about the possible risks of NSAID use and should “be vigilant for signs of drug associated acute kidney injury in all patients.”