BMJ:利尿剂+ACEI+NSAID 当心急性肾损伤
2013-01-21 BMJ CMT 吴君德 整理
一项加拿大研究显示，利尿剂、ACEI/血管紧张素受体阻滞剂（ARB）、非类固醇类抗炎药（NSAID）联用可增加急性肾损伤的风险。论文发表于《英国医学杂志》（BMJ 2013, 346:e8525）。 研究纳入了487372例降压药使用患者。中位随访5.9年，结果出现2215例急性肾损伤。同时使用利尿剂或ACEI/ARB联合NSAID并不升高急性肾损伤的发病率，而这三类
一项加拿大研究显示，利尿剂、ACEI/血管紧张素受体阻滞剂（ARB）、非类固醇类抗炎药（NSAID）联用可增加急性肾损伤的风险。论文发表于《英国医学杂志》（BMJ 2013, 346:e8525）。
研究纳入了487372例降压药使用患者。中位随访5.9年，结果出现2215例急性肾损伤。同时使用利尿剂或ACEI/ARB联合NSAID并不升高急性肾损伤的发病率，而这三类药物联用却使急性肾损伤的发病率升高[率比（RR）=1.31]。二次分析显示，在开始用药的30天内，发生急性肾损伤的风险最高（RR=1.82）。
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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本网站所有内容来源注明为“梅斯医学”或“MedSci原创”的文字、图片和音视频资料，版权均属于梅斯医学所有。非经授权，任何媒体、网站或个人不得转载，授权转载时须注明来源为“梅斯医学”。其它来源的文章系转载文章，或“梅斯号”自媒体发布的文章，仅系出于传递更多信息之目的，本站仅负责审核内容合规，其内容不代表本站立场，本站不负责内容的准确性和版权。如果存在侵权、或不希望被转载的媒体或个人可与我们联系，我们将立即进行删除处理。
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