Hepatotoxicity risk factors and acetaminophen dose adjustment, do prescribers give this issue adequate consideration? a French university hospital study.
ObjectivesConcurrent use of non-steroidal anti-inflammatory drugs (NSAIDs) with diuretics and reninangiotensin-aldosterone system inhibitors (RAASI) has been associated to an increased risk of developing acute kidney injury (AKI) in ambulatory setting. There is currently no information on AKI prevalence in hospitalized patients where initiation of NSAID prescription is quite frequent. The aim of our study was to assess the prevalence of AKI in patients treated with diuretics and/or RAASI in the hospital setting when NSAIDs are initiated.
MethodsRetrospective single center study on inpatients receiving triple or dual association. AKI was established according to evidence-based clinical practice guidelines in kidney disease (Kidney Disease Improving Global Outcome, KDIGO criteria) using the following criteria : increase in SCr by ≥ 0.3mg/dL (or ≥26.5 µmol/L) within 48 hours or increase in SCr to ≥ 1.5 times baseline occurring within the last 7 days.
ResultsAKI was identified in 5 of 151 patients (3.3%) treated with both diuretics and RAASI in whom NSAIDs were initiated with a 49 µM average increase in SCr within 48h compared to baseline. AKI was identified in 2 of 117 (1.7%) patients treated with diuretics and NSAIDs, and in 1 of 427 (0.23%) patients treated with RAASI and NSAIDs. The average increase in SCr within 2 days was 29µM. No Aki was identified in a control group of 1,886 patients treated by diuretics and RAASI with no NSAIDs initiation during their hospitalization.
ConclusionInitiation of NSAID therapy in hospitalized patients already treated with diuretics and RAASI is a risk factor for AKI. The risk of AKI with the triple association appeared higher than with the dual association.
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