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Triple drug combo increases acute kidney injury risk

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A triple combination of blood pressure drugs and anti-inflammatories increases the risk of acute kidney injury by almost a third, a new Canadian study has revealed.

The research examined whether certain combinations of anti-hypertensive drugs and non-steroidal anti-inflammatory drugs (NSAIDs) could be linked to kidney problems.

Such medications are commonly prescribed together, particularly in elderly people with a number of long-term conditions.

Researchers from the Jewish General Hospital and McGill University in Montreal, Canada, identified 487,372 people who received anti-hypertensive drugs between 1997 and 2008, using the world’s largest computerised database of primary care records.

The anti-hypertensive drugs included angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs) and diuretics, which were frequently prescribed alongside NSAIDs.

In total, 2,215 patients were diagnosed with acute kidney injury requiring hospital admission or dialysis during the near six years they were tracked, or seven in 10,000 person-years.

Patients taking a double therapy combination of either a diuretic or an ACE inhibitors or ARB with an NSAID were at no increased risk of kidney injury, the study found.

However, the risk of acute kidney injury was almost a third (31%) higher in patients who had been prescribed a triple therapy combination of a diuretic with an ACE inhibitor or ARB and an NSAID.

The risk was especially heightened in the first 30 days of treatment, during which the risk of acute kidney injury was 82% higher for patients on triple drug combinations.

While the absolute risk for individual patients remains low, prescribers and patients should be aware of the possible consequences of triple drug combinations, the researchers said.

“Although anti-hypertensive drugs have cardiovascular benefits, vigilance may be warranted when they are used concurrently with NSAIDs,” the study’s authors concluded.

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