Concurrent use of diuretics, angiotensin converting enzyme inhibitors, and angiotensin receptor blockers with non-steroidal anti-inflammatory drugs and risk of acute kidney injury: nested case-control study.
Concurrent use of diuretics, angiotensin converting enzyme inhibitors, and angiotensin receptor blockers with non-steroidal anti-inflammatory drugs and risk of acute kidney injury: nested case-control study.
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DOI：
10.1136/bmj.e8525
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发表时间：
2013-01-08
期刊：
影响因子：
--
通讯作者：
Suissa S
中科院分区：
文献类型：
--
作者：
Lapi F;Azoulay L;Yin H;Nessim SJ;Suissa S
目的评估利尿剂、血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂联合非甾体抗炎药（NSAID）的双重治疗和上述两种抗高血压药物联合NSAIDs的三联治疗是否与急性肾损伤风险增加相关。设计回顾性队列研究，采用巢式病例对照分析。设置一般做法贡献的数据，英国临床实践研究数据链接到医院流行病学统计数据库。研究对象：487372名抗高血压药物使用者。主要结果测量与目前使用抗高血压药物和NSAID的双重和三重治疗组合相关的急性肾损伤的率比和95%置信区间。结果在平均5.9（SD 3.4）年的随访中，确定了2215例急性肾损伤（发病率为7/10000人年）。总体而言，目前使用含有利尿剂或血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂与NSAID的双重治疗组合与急性肾损伤发生率增加无关。相比之下，目前使用三联疗法与急性肾损伤发生率增加相关（率比1.31，95%置信区间1.12 - 1.53）。在次要分析中，在使用的前30天观察到最高风险（率比1.82，1.35 - 2.46）。结论：利尿剂、血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂和NSAID组成的三联疗法与急性肾损伤风险增加相关。治疗开始时风险最大。虽然抗高血压药物对心血管有益，但与NSAID同时使用时应保持警惕。
Objectives To assess whether a double therapy combination consisting of diuretics, angiotensin converting enzyme inhibitors, or angiotensin receptor blockers with addition of non-steroidal anti-inflammatory drugs (NSAIDs) and the triple therapy combination of two of the aforementioned antihypertensive drugs to which NSAIDs are added are associated with an increased risk of acute kidney injury. Design Retrospective cohort study using nested case-control analysis. Setting General practices contributing data to the UK Clinical Practice Research Datalink linked to the Hospital Episodes Statistics database. Participants A cohort of 487 372 users of antihypertensive drugs. Main outcome measures Rate ratios with 95% confidence intervals of acute kidney injury associated with current use of double and triple therapy combinations of antihypertensive drugs with NSAIDs. Results During a mean follow-up of 5.9 (SD 3.4) years, 2215 cases of acute kidney injury were identified (incidence rate 7/10 000 person years). Overall, current use of a double therapy combination containing either diuretics or angiotensin converting enzyme inhibitors or angiotensin receptor blockers with NSAIDs was not associated with an increased rate of acute kidney injury. In contrast, 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). Conclusions A triple therapy combination consisting of diuretics with angiotensin converting enzyme inhibitors or angiotensin receptor blockers and NSAIDs was associated with an increased risk of acute kidney injury. The risk was greatest at the start of treatment. Although antihypertensive drugs have cardiovascular benefits, vigilance may be warranted when they are used concurrently with NSAIDs.
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影响因子：
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