BACKGROUND Elderly, patients with chronic kidney disease (CKD) and patients with heart failure who continue using renin-angiotensin-aldosterone-system (RAAS) inhibitors, diuretics, or non-steroidal-anti-inflammatory drugs (NSAIDs) during times of fluid loss have a high risk of developing complications like acute kidney injury (AKI). The aim of this study was to assess how often advice to discontinue high-risk medication was offered to high-risk patients consulting the general practitioner (GP) with increased fluid loss. Furthermore, we assessed the number and nature of the complications that occurred after GP consultation. METHODS We performed a cross-sectional study with patients from seven Dutch general practices participating in the Family Medicine Network between 1 and 6-2013 and 1-7-2018. We included patients who used RAAS-inhibitors, diuretics, or NSAIDs, and had at least one of the following risk factors: age ≥ 70 years, CKD, or heart failure. From this population, we selected patients with a 'dehydration-risk' episode (vomiting, diarrhoea, fever, chills, or gastrointestinal infection). We manually checked their electronic patient files and assessed the percentage of episodes in which advice to discontinue the high-risk medication was offered and whether a complication occurred in 3 months after the 'dehydration-risk' episode. RESULTS We included 3607 high-risk patients from a total of 44.675 patients (8.1%). We found that patients were advised to discontinue the high-risk medication in 38 (4.6%) of 816 'dehydration-risk' episodes. In 59 of 816 episodes (7.1%) complications (mainly AKI) occurred. CONCLUSIONS Dutch GPs do not frequently advise high-risk patients to discontinue high-risk medication during 'dehydration-risk' episodes. Complications occur frequently. Timely discontinuation of high-risk medication needs attention.

中文翻译：

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通过暂时停药预防高危患者的急性肾损伤-一项常规研究。

背景技术老年人，患有慢性肾脏疾病（CKD）的患者和心力衰竭的患者在流失期间继续使用肾素-血管紧张素-醛固酮系统（RAAS）抑制剂，利尿剂或非甾体抗炎药（NSAIDs）患急性肾损伤（AKI）等并发症的风险很高。这项研究的目的是评估向高危患者咨询全科医生（GP）输液量增加的中止高危药物治疗建议的频率。此外，我们评估了GP咨询后发生的并发症的数量和性质。方法我们在2013年1月6日至6日和2018年1月7日之间，对参与家庭医学网络的七个荷兰普通科患者进行了横断面研究。我们纳入了使用RAAS抑制剂的患者，利尿剂或NSAID，并且至少具有以下危险因素之一：年龄≥70岁，CKD或心力衰竭。从这一人群中，我们选择了具有“脱水风险”发作（呕吐，腹泻，发烧，发冷或胃肠道感染）的患者。我们手动检查了他们的电子病历并评估了提供高危药物治疗建议的发作百分比，以及“脱水风险”发作后3个月内是否发生了并发症。结果我们纳入了44.675名患者中的3607名高危患者（8.1％）。我们发现，在816例“脱水风险”发作中有38例（4.6％）被建议停止使用高危药物。在816次发作中，有59次（7.1％）发生了并发症（主要是AKI）。结论荷兰全科医生不建议高危患者在“脱水风险”发作期间停止高危药物治疗。并发症经常发生。及时停止使用高危药物需要引起注意。