Evid Based Med doi:10.1136/eb-2013-101273
  • Harm
  • Cohort study

Use of diuretics with ACE inhibitors or angiotensin receptor blockers and NSAIDs increases the risk of acute kidney injury

  1. Debbie L Cohen
  1. Department of Medicine, Renal Division, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  1. Correspondence to: Dr Raymond R Townsend
    Department of Medicine, Renal Division, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA; townsend{at}

Commentary on: Lapi F, Azoulay L, Yin H, et al. Concurrent use of diuretics, angiotensin converting enzyme inhibitors, and angiotensin receptor blockers with non-steroidal anti-inflammatory drugs and risk of acute kidney injury: nested case-control study. BMJ 2013;346:e8525.


Acute kidney injury (AKI) is increasing both in the USA and Europe.1 ,2 Most people with AKI return to baseline renal function, but AKI predisposes some patients to an increased risk of chronic kidney disease (CKD) and end-stage renal disease (ESRD).3 ,4 Medications contribute to AKI whether administered in hospital such as aminoglycoside antibiotics, or when prescribed for outpatients, such as non-steroidal anti-inflammatory drugs (NSAIDs) whose adverse effects are seen more often to involve the gastrointestinal tract rather than kidneys. Lapi and colleagues report the incidence of hospitalised AKI …

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