title: Effects of short-term addition of NSAID to diuretics and/or RAAS-inhibitors on blood pressure and renal function.
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.
  
  
  METHODS
  One teaching hospital in the Netherlands.
  
  
  METHODS
  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).
  
  
  METHODS
  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 m(2).
  
  
  CONCLUSIONS
  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 m(2)) 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.
authors.affiliation: Department of Pharmacy, Diaconessen Hospital Meppel & Bethesda Hospital Hoogeveen, Hoogeveenseweg 38, Postbox 502, 7940 AM, Meppel, The Netherlands. NYGARDP@noorderboog.nl
authors.forename: Peder
authors.initials: P
authors.lastname: Nygård
authors.forename: Frank G A
authors.initials: FG
authors.lastname: Jansman
authors.forename: Willemien J
authors.initials: WJ
authors.lastname: Kruik-Kollöffel
authors.forename: Alex F W
authors.initials: AF
authors.lastname: Barnaart
authors.forename: Jacobus R B J
authors.initials: JR
authors.lastname: Brouwers
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage*; D001794:Blood Pressure / Q000187:drug effects* / Q000502:physiology; D015331:Cohort Studies; D004232:Diuretics / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007668:Kidney / Q000187:drug effects* / Q000502:physiology; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods; D011446:Prospective Studies; D012084:Renin-Angiotensin System / Q000187:drug effects* / Q000502:physiology; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D004232:Diuretics