GARCIA CAMIN, Rosa Maria et al. Fracaso renal agudo secundario a combinación de inhibidores del sistema renina-angiotensina, diuréticos y AINES: "la Triple Whammy". []. , 35, 2, pp.197-206. ISSN 1989-2284.

^les^aIntroducción: Inhibidores del sistema renina-angiotensina (IECAS/ARA II), diuréticos y AINES, combinación conocida como "Triple Whammy", pueden producir descenso de filtrado glomerular y fracaso renal agudo (FRA). Objetivos: Describir la incidencia de FRA para cada tipo de fármaco y sus combinaciones. Caracterizar el perfil de paciente que ingresa por FRA extrahospitalario secundario a fármacos de la Triple Whammy (FRAETW), evaluando costes y mortalidad. Métodos: estudio observacional retrospectivo realizado durante 15 meses y desarrollado en tres etapas: - 1^o Etapa transversal de identificación y descripción de los ingresos hospitalarios por FRAETW. - 2^o Etapa de seguimiento de una cohorte ambulatoria consumidora de estos fármacos (15.307 consumidores) - 3^o Etapa de cohortes para evaluar costes y mortalidad, contrastando 62 pacientes ingresados con FRAETW, con 62 pacientes sin FRA, apareados por especialidad médica, sexo, edad y comorbilidad según Clinical Risk Groups. Resultados: 85 ingresos por FRAETW, 78% mayores de 70 años. Incidencia poblacional de FRAETW: 3,40 casos/1.000 consumidores/año (IC95% 2,59-4,45). Por categorías: AINES + diuréticos 8,99(IC95% 3,16-25,3), la "Triple Whammy" 8,82(IC 95% 4,4-17,3), IECA/ARA II + diuréticos 6,87(IC95% 4,81-9,82) y la monoterapia con diuréticos 3,31(IC95% 1,39-7,85). Estancia media 7,6 días (DE 6,4), estimándose coste medio evitable de 214.604 €/100.000 habitantes/año. Mortalidad del 11,3% durante el ingreso y del 38,7% a los 12 meses, sin diferencias significativas con los controles. Conclusiones: El tratamiento con IECA, ARA II, diuréticos y/o AINES presenta elevada incidencia de ingreso por FRA, siendo los diuréticos en monoterapia, doble y triple terapia combinada los que ocasionan la mayor incidencia. El FRAETW supone elevados costes sanitarios y muertes evitables.^len^aIntroduction: Renin-angiotensin system inhibitors (ACEIs/ARBs), diuretics and non-steroidal anti-inflammatory drugs (NSAIDs) - a combination also known as the Triple Whammy (TW) - can reduce the glomerular filtration rate (GFR) and lead to acute kidney injury (AKI). Objective: To study the incidence of AKI due to any type or combination of drugs. To describe patient profiles admitted for outpatient AKI due to TW drugs (AKI-TW), hospital costs and mortality. Methods: This was a 15-month retrospective observational study, developed in 3 stages: - First stage: Cross-sectional description of outpatient AKI-TW hospitalisation episodes. - Second stage: Outpatient drug consumer cohort follow-up (15,307 individuals). - Third stage: Mortality and costs evaluation. It included 62 patients with AKI-TW and 62 without, paired by medical specialty, gender, age and comorbidity according to the Clinical Risk Groups (CRG) system. Results: There were 85 hospitalisation episodes attributed to AKI-TW; 78% of cases were older than 70 years. Incidence of AKI-TW was 3.40 cases/1000 users/year (95% CI: 2.59-4.45). Double therapy with NSAIDs + diuretics was 8.99 (95%CI 3.16-25.3); Triple Whammy was 8.82 (95% CI 4.4-17.3); double therapy with ACEIs/ARBs + diuretics 6.87 (95% CI 4.81-9.82); and diuretics in monotherapy 3.31(95% CI 1.39-7.85). Mean stay for cases was 7.6 days (SD 6.4) and total avoidable costs were €214,604/100,000 inhabitants/year. Mortality during hospital stay and at 12 months was 11.3% and 40.3% respectively, without significant differences between groups. Conclusions: Triple Whammy therapy is associated with a high incidence of hospital admission for AKI. Diuretics in monotherapy, double and combined triple therapy are associated with a high incidence of AKI. AKI-TW involves high hospital costs and avoidable mortality.

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