著者

國津 侑貴 磯野 哲一郎 平 大樹 寺田 智祐

出版者

公益社団法人 日本薬学会

雑誌

YAKUGAKU ZASSHI (ISSN:00316903)

巻号頁・発行日

vol.139, no.11, pp.1457-1462, 2019-11-01 (Released:2019-11-01)

参考文献数

16

被引用文献数

1 4

---

Recently, there have been reports that the combination of renin angiotensin inhibitors, diuretics, and non-steroidal anti-inflammatory drugs increases the risk of acute kidney injury (AKI). This combination has been dubbed the “Triple Whammy”. However, there have been no reports about its chronic effects on the kidney. In this study, we investigated the chronic effects of the “Triple Whammy” on kidney function. There were 203 outpatients who were prescribed this combination in our hospital for 5 years. We excluded patients who could also confirm the combination in the previous year and patients for whom laboratory data were unavailable, thus, leaving a target patient group of 95 patients. The average estimated glomerular filtration rate (eGFR) decreased significantly from 62.6 to 58.9 mL/min/1.73 m2 immediately after administering the combination (p<0.01). Although no patients were diagnosed with AKI within 90 days after being administered the combination, 7.4% of patients exhibited a ≥25% reduction in eGFR compared with that before commencing the combination. Correlation analysis of gender, age, past renal function, and renal function change demonstrated that eGFR before administration of the combination negatively correlated with changes in eGFR (p<0.01). Considering the effects of individual differences, eGFR changes before and after administering the combination were compared using a case-crossover design and eGFR after administering the combination was found to be significantly reduced (p<0.01). Therefore, it appears that the “Triple Whammy” may cause not only AKI but also chronic renal degeneration.

著者

磯野 哲一郎 國津 侑貴 増田 恭子 平 大樹 荒木 久澄 荒木 信一 宇津 貴 寺田 智祐

出版者

一般社団法人日本医療薬学会

雑誌

医療薬学 (ISSN:1346342X)

巻号頁・発行日

vol.43, no.11, pp.601-609, 2017-11-10 (Released:2018-11-10)

参考文献数

29

被引用文献数

1 3

---

The proper use of drugs with renal excretion and nephrotoxicity is an urgent problem due to the increase in CKD patients. We have been sharing renal function data on CKD patients among medical staff, including community pharmacists, using the CKD sticker since March, 2012 in Shiga. The CKD sticker is affixed to the medication log book of CKD patients. We performed questionnaire surveys of all community pharmacies in Shiga for five years from 2012 to 2016, and examined the utility of the CKD sticker. The CKD sticker was recognized at 98.6% of pharmacies in 2016. Pharmacies attended by patients with the CKD sticker increased to 68.8% in 2016. In addition, there were no local differences among 9 branches in the Shiga Pharmacist Society in 2016. The number of pharmacies that performed questionable inquiries based on the CKD sticker increased from 7.7% in 2012 to 24.7% in 2016. Pharmacies that inquired about patients with CKD stickers greatly increased in 2016, and the number of prescription changes increased. The spread of CKD stickers was observed throughout the prefecture, and this study demonstrated that the CKD sticker was a useful tool for questionable inquiries. The CKD sticker helped to avoid the use of drugs in cases with nephrotoxicity and to reduce the quantity of drugs in cases with renal excretion, allowing for safe medication of CKD patients.