{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T16:56:01Z","timestamp":1792688161325,"version":"4.5.0"},"reference-count":27,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2023,4,5]],"date-time":"2023-04-05T00:00:00Z","timestamp":1680652800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100008530","name":"European Regional Development Fund","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100008530","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100017266","name":"Gobierno de Navarra","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100017266","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacoepidemiology and Drug"],"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Concomitant use of diuretics, renin\u2013angiotensin\u2013aldosterone system (RAAS) inhibitors, and non\u2010steroidal anti\u2010inflammatory drugs (NSAIDs) or metamizole, known as \u2018triple whammy\u2019 (TW), has been associated with an increased risk of acute kidney injury (AKI). Nevertheless, there is still uncertainty on its impact in hospitalisation and mortality. The aim of the study was to analyse the association between exposure to TW and the risk of hospitalisation for AKI, all\u2010cause mortality and the need for renal replacement therapy (RRT).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A case\u2013control study nested in a cohort of adults exposed to at least one diuretic or RAAS inhibitor between 2009 and 2018 was carried out within the Pharmacoepidemiological Research Database for Public Health Systems (BIFAP). Patients hospitalised for AKI between 2010 and 2018 (cases) were matched with up to 10 patients of the same age, sex and region of Spain who had not been hospitalised for AKI as of the date of hospitalisation for AKI of the matching case (controls). The association between TW exposure versus non\u2010exposure to TW and outcome variables was analysed using logistic regression models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 480\u2009537 participants (44\u2009756 cases and 435\u2009781 controls) were included (mean age: 79\u2009years). The risk of hospitalisation for AKI was significantly higher amongst those exposed to TW [adjusted odds ratio (aOR) 1.36, 95% confidence interval (95%CI) 1.32\u20131.40], being higher with current (aOR 1.60, 95%CI 1.52\u20131.69) and prolonged exposure (aOR 1.65, 95%CI 1.55\u20131.75). No significant association was found with the need of RRT. Unexpectedly, mortality was lower in those exposed to TW (aOR 0.81, 95%CI 0.71\u20130.93), which may be influenced by other causes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Vigilance should be increased when diuretics, RAAS inhibitors, and NSAIDs or metamizole are used concomitantly, especially in patients at risk such as elderly patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pds.5621","type":"journal-article","created":{"date-parts":[[2023,3,24]],"date-time":"2023-03-24T02:26:06Z","timestamp":1679624766000},"page":"898-909","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Effect of the combination of diuretics, renin\u2013angiotensin\u2013aldosterone system inhibitors, and non\u2010steroidal anti\u2010inflammatory drugs or metamizole (triple whammy) on hospitalisation due to acute kidney injury: A nested case\u2013control study"],"prefix":"10.1002","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1811-9099","authenticated-orcid":false,"given":"Dulce Maria","family":"Calvo","sequence":"first","affiliation":[{"name":"Autonomous University of Barcelona (UAB)  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9143-5709","authenticated-orcid":false,"given":"Luis Carlos","family":"Saiz","sequence":"additional","affiliation":[{"name":"Unit of Innovation and Organization, Navarre Health Service Navarra Health Research Institute (IdiSNA)  Pamplona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2272-7086","authenticated-orcid":false,"given":"Leire","family":"Leache","sequence":"additional","affiliation":[{"name":"Unit of Innovation and Organization, Navarre Health Service Navarra Health Research Institute (IdiSNA)  Pamplona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7700-7911","authenticated-orcid":false,"given":"Maria Concepci\u00f3n","family":"Celaya","sequence":"additional","affiliation":[{"name":"Subdirectorate of Pharmacy and Health Benefits, Navarre Health Service Navarra Health Research Institute (IdiSNA)  Pamplona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3229-6614","authenticated-orcid":false,"given":"Marta","family":"Guti\u00e9rrez\u2010Valencia","sequence":"additional","affiliation":[{"name":"Unit of Innovation and Organization, Navarre Health Service Navarra Health Research Institute (IdiSNA)  Pamplona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2225-8323","authenticated-orcid":false,"given":"Alvaro","family":"Alonso","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Rollins School of Public Health Emory University  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3396-2102","authenticated-orcid":false,"given":"Juan","family":"Erviti","sequence":"additional","affiliation":[{"name":"Unit of Innovation and Organization, Navarre Health Service Navarra Health Research Institute (IdiSNA)  Pamplona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8513-239X","authenticated-orcid":false,"given":"Natalia","family":"Alzueta","sequence":"additional","affiliation":[{"name":"Subdirectorate of Pharmacy and Health Benefits, Navarre Health Service Navarra Health Research Institute (IdiSNA)  Pamplona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9225-5323","authenticated-orcid":false,"given":"Amaya","family":"Echeverr\u00eda","sequence":"additional","affiliation":[{"name":"Subdirectorate of Pharmacy and Health 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