COMBINATION PHARMACOTHERAPY AS A RISK FACTOR FOR THE INCIDENCE OF RENAL FAILURE IN THE ELDERLY
Introduction: Safety issues of drug combinations (DC) are always in the focus of attention of physicians, and special attention is required for elderly patients. Especially this problem relevant in recent years due to the increased level of polypragmasy in comorbid patients receiving drug therapy for the treatment of several diseases. It is possible to predict and prevent adverse effects of drug combinations, if to know the mechanisms of drug interactions.
Aim: To determine the risk factors of complications arterial hypertension pharmacotherapy in the combined use of antihypertensive and antiagregant drugs in the elderly.
Materials and methods: The study design was a single-center randomized prospective clinical trial. A total 343 patients who were followed up on an outpatient and inpatient basis for more than 3 years (mean follow-up period 4.1±1.0 years) were included in the study. Of these, 209 were women and 134 were men. There were 236 patients in the age group 66-70 years (68.8%), and 107 patients (31.2%) were older than 70 years (up to 80 years at the beginning of the study). A comparison of outcomes categorized into 2 groups - vascular and renal complications - was performed to determine the main outcomes. The endpoints of the study were: development of renal insufficiency II stage, patient death from any cause; development of acute coronary or cerebral circulatory failure.
Results: During the analysis of data obtained during an average of 4.1±1.0 years, 104 cases of CRI II stage development were identified. Co-administration of ACE inhibitors with antiaggregant drug was accompanied by statistically significant increase in the incidence of CRI II stage (incidence ratio 1.31 with 95% CI from 1.12 to 1.53).
Conclusion: Thus, the use in clinical practice for a large population of patients with cardiovascular diseases combinations of ACE inhibitors with NSAIDs significantly increase the risk of renal failure. Particular caution in the use of such a combination is required in risk groups: in elderly patients, with concomitant CKD, and comorbid conditions. In case of use of NSAIDs in patients receiving ACE inhibitors, monitoring of renal function parameters is required.
Аigerim Ye. Mussina1, https://orcid.org/0000-0002-0114-5397
Raikhan Ye. Tuleutayeva1, https://orcid.org/0000-0002-0462-5230
Akzhan B. Zhumatay1, https://orcid.org/0000-0003-4558-5316
Assel Ye. Kakytayeva1, https://orcid.org/0000-0003-1943-5859
Zhanyl B. Imatullina1, https://orcid.org/0009-0005-3082-3811
Adil B. Zhanekenov1, Assem A. Rakhimzhanova1
1 Semey Medical University, Pharmacology department named by professor M.N. Mussin,
Semey, Republic of Kazakhstan.
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Mussina А.Ye., Tuleutayeva R.Ye., Zhumatay A.B., Kakytayeva A.Ye., Imatullina Zh.B., Zhanekenov A.B., Rakhimzhanova A.A. Combination pharmacotherapy as a risk factor for the incidence of renal failure in the elderly // Nauka i Zdravookhranenie [Science & Healthcare]. 2023, (Vol.25) 3, pp. 108-112. doi 10.34689/SH.2023.25.3.014Related publications:
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