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.

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外部データベース (DOI)

Twitter (18 users, 21 posts, 56 favorites)

@natumegu06 https://t.co/KRGJEtasc4 併用薬で腎機能障害を生じるtriple whammyが知られてます。
Triple Whammy。AKIと診断されず(診断基準に満たない)とも一定程度のeGFR低下が生じ得ることを頭の片隅に置いておく必要があるなー
「#TripleWhammy」(レニン・アンジオテンシン系阻害薬,利尿薬,非ステロイド性抗炎症薬の3剤併用)による腎機能への慢性的な影響 NSAIDは避けたいけど、RAだったりするとやめにくい時もあるよね
【SY10-2】3剤併用の中長期的な腎機能への影響 https://t.co/lZqfaA1tb8 #jsnp2021
@kazu08xx @kombude10 こちらの所見では 急性腎障害への影響は微妙なところですが慢性的には下がる可能性があるので長期的だと嫌だなぁという印象です。NSAIDsの投与が短期ならまぁ…って感じですがこの時期、脱水とかあると注意したいなぁとか思ったり。 https://t.co/yrYbAKGV2M

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