Patients who mix a diuretic and renin-angiotensin system inhibitor with a nonsteroidal anti-inflammatory drug could face a higher risk of developing acute kidney injury.

Mixing BP Meds with an NSAID may be a ‘triple hit’ for the kidneys – MedicineNet Health News

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Megan Brooks
12 May 2022

A new analysis has confirmed that patients who mix a diuretic and a renin-angiotensin system (RAS) inhibitor with a non-steroidal anti-inflammatory drug (NSAID) can have a higher risk of acute kidney injury (AKI).

The study also looked at risk factors associated with the effect of triple therapy with these factors, called AKI ‘triple hit’.

“It’s not that everyone who takes this group of drugs will have problems,” Anita Layton, Ph.D., University of Waterloo, Ontario, Canada, said in a statement. “But the research shows it’s problematic enough that you have to be careful.”

The study was published online April 4 in Mathematical Biological Sciences.

In a previous study, triple therapy with a diuretic, a RAS inhibitor, and an NSAID was associated with a 31% increased risk of AKI, compared to a diuretic and RAS inhibitor treatment alone.

However, the factors that predispose some patients to developing ‘triple-hit’ AKI are unclear.

To understand the mechanism by which triple therapy increases the risk of RA, Layton and colleagues used computational models to measure interactions between concomitant use of a diuretic, RAS inhibitors, and NSAIDs.

They identified dehydration and high sensitivity to drug therapy as major contributing factors to the development of triple-hit AKI.

Their model simulations suggested that reduced water intake, muscular response (that is, the arterioles’ reflexive response to changes in blood pressure to maintain steady blood flow), and drug sensitivity “may predispose patients with hypertension to develop a triple-kick effect. AKI,” they write.

They added, “We hypothesize that individuals with impaired muscular response may be particularly susceptible to TRI. In addition, increased drug sensitivity or decreased water intake could predispose patients to a three-fold stroke of rheumatoid arthritis. “.

In the absence of additional risk factors, the study team says, there was no indication of a higher risk of AKI when combining an ACE inhibitor with an NSAID.

In contrast, when an ACE inhibitor, a diuretic, and an NSAID are combined, the regulatory mechanisms of blood pressure and glomerular filtration rate (GFR) are simultaneously interrupted, they report.

They wrote, “Perhaps not unexpectedly, simulations indicate that triple therapy reduces GFR more than single or dual treatments in all individuals. However, under triple therapy, urine volume and GFR were not expected to decrease sufficiently to refer to AKI”. “This finding is consistent with the fact that only a small portion of individuals develop ARD after triple therapy.”

The researchers concluded that they expect that otherwise healthy hypertensive patients would be able to tolerate triple therapy, in the absence of these aggravating factors.

However, it is wise to “always use caution when mixing medications,” Layton said | Medscape Heart.

She noted, “The triple hit of acute renal failure is well known among nephrologists and nephrologists. To what extent non-specialists know, it is not clear.”

“Importantly, NSAIDs can be obtained without a prescription, and triple-hit AKI is not common knowledge outside the medical community,” Layton said.

This research was supported by the Canadian Research Chair Program 150 and the Natural Sciences and Engineering Research Council of Canada. The authors declared no conflict of interest.


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Source: Medscape, May 12, 2022. Math Biosci. Posted online April 4, 2022.

2022-05-13 17:04:08

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