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Effects of short-term addition of NSAID to diuretics and/or RAAS-inhibitors on blood pressure and renal function

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Abstract

Background The combined post-operative use of diuretics and/or renin-angiotensin-aldosterone system (RAAS) inhibitors may increase the risk of nonsteroidal anti-inflammatory drug (NSAID) associated renal failure because of a drug–drug interaction. Objective The aim of this study was to investigate the effect of the short-term (<4 days) post-operative combined use of NSAIDs with diuretics and/or RAAS inhibitors on renal function and blood pressure. Setting One teaching hospital in the Netherlands. Method The study-design was a prospective, observational cohort-study. Based on postoperative treatment with NSAIDs, the intervention-group was compared to a control-group (no NSAIDs treatment). Main outcome measure Systolic blood pressure and renal function expressed by the estimated glomular filtration rate (eGFR) calculated with the modification of renal desease formula. Results 97 patients were included in the intervention-group, 53 patients in the control-group. Patient characteristics were comparable except for one variable: ‘combined use of a diuretic with a RAAS inhibitor’ which was higher in the control-group (62 vs. 43 %, p = 0.046). Odds ratio for clinically relevant increase in systolic blood pressure was 0.66 (CI95 % 0.3–1.5). Odds ratio for clinical relevant decrease in renal function was 2.44 (CI95 % 1.1–5.2). On day 4 eGFR of 3 patients in the intervention- and 1 in the control-group was <50 ml/min/1.73 m2. Conclusion Odds ratios showed no significant difference of a clinically relevant increase in systolic blood pressure but showed a higher risk for a clinically relevant decrease in renal function in the intervention group. However this decrease resulted in a relevant impaired renal function (<50 ml/min/1.73 m2) in only 3 patients in the interventiongroup and 1 patient in the control-group. In the post-operative patient, without preexisting impaired renal function, concurrent diuretics and/or renin-angiotensinaldosterone system inhibitor therapy can be combined with short-term NSAID treatment.

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Acknowledgments

The authors would like to thank all patients who participated in the study. Special thanks go to R. Saleem for her work in including patients and gathering data. We are grateful to M. Arbouw and W. van der Zwet for their help with the statistical analysis.

Funding

The work was funded by the Deventer Ziekenhuis, Deventer, The Netherlands.

Conflicts of interest

None.

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Authors and Affiliations

  1. Department of Pharmacy, Diaconessen Hospital Meppel & Bethesda Hospital Hoogeveen, Hoogeveenseweg 38, Postbox 502, 7940 AM, Meppel, The Netherlands

    Peder Nygård

  2. Department of Clinical Pharmacy, Deventer Hospital, Deventer, The Netherlands

    Frank G. A. Jansman & Willemien J. Kruik-Kollöffel

  3. Department of Pharmacotherapy and Pharmaceutical Care, University Groningen, Groningen, The Netherlands

    Frank G. A. Jansman & Jacobus R. B. J. Brouwers

  4. Department of Orthopaedics, Deventer Hospital, Deventer, The Netherlands

    Alex F. W. Barnaart

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  1. Peder Nygård
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  2. Frank G. A. Jansman
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  5. Jacobus R. B. J. Brouwers
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Correspondence to Peder Nygård.

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Nygård, P., Jansman, F.G.A., Kruik-Kollöffel, W.J. et al. Effects of short-term addition of NSAID to diuretics and/or RAAS-inhibitors on blood pressure and renal function. Int J Clin Pharm 34, 468–474 (2012). https://doi.org/10.1007/s11096-012-9631-5

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  • DOI: https://doi.org/10.1007/s11096-012-9631-5

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