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Association Of Angiotensin-Converting Enzyme Inhibitor Or Angiotensin Receptor Blocker Use With Outcomes After Acute Kidney Injury

Sandeep Singh Brar, Feng Ye, Matthew T. James, Brenda R. Hemmelgarn, Scott W. Klarenbach, Neesh I Pannu
Published 2018 · Medicine
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Importance Patients with acute kidney injury (AKI) are at an increased long-term risk of death. Effective strategies that improve long-term outcomes in patients with AKI are unknown. Objective To evaluate whether the use of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) after hospital discharge is associated with better outcomes in patients with AKI. Design, Setting, and Participants This retrospective cohort study used data from the Alberta Kidney Disease Network population database to evaluate 46 253 adults 18 years or older with an episode of AKI during a hospitalization between July 1, 2008, and March 31, 2015, in Alberta, Canada. All patients who survived to hospital discharge were followed up for a minimum of 2 years. Exposures Use of an ACEI or ARB within 6 months after hospital discharge. Main Outcomes and Measures The primary outcome was mortality; secondary outcomes included hospitalization for a renal cause, end-stage renal disease (ESRD), and a composite outcome of ESRD or sustained doubling of serum creatinine concentration. An AKI was defined as a 50% increase between prehospital and peak in-hospital serum creatinine concentrations. Propensity scores were used to construct a matched-pairs cohort of patients who did and did not have a prescription for an ACEI or ARB within 6 months after hospital discharge. Results The study evaluated 46 253 adults (mean [SD] age, 68.6 [16.4] years; 24 436 [52.8%] male). Within 6 months of discharge, 22 193 (48.0%) of the participants were prescribed an ACEI or ARB. After adjustment for comorbidities, ACEI or ARB use before admission, demographics, baseline kidney function, other factors related to index hospitalization, and prior health care services, ACEI or ARB use was associated with lower mortality in patients with AKI after 2 years (adjusted hazard ratio, 0.85; 95% CI, 0.81-0.89). However, patients who received an ACEI or ARB had a higher risk of hospitalization for a renal cause (adjusted hazard ratio, 1.28; 95% CI, 1.12-1.46). No association was found between ACEI or ARB use and progression to ESRD. Conclusions and Relevance Among patients with AKI, ACEI or ARB therapy appeared to be associated with lower mortality but a higher risk of hospitalization for a renal cause. These results suggest a potential benefit of ACEI or ARB use after AKI, but cautious monitoring for renal-specific complications may be warranted.
This paper references
Epidemiology of acute renal failure: a prospective, multicenter, community-based study. Madrid Acute Renal Failure Study Group.
Fernando Liaño (1996)
Coding Algorithms for Defining Comorbidities in ICD-9-CM and ICD-10 Administrative Data
Hude Quan (2005)
Kidney function decline after a non-dialysis-requiring acute kidney injury is associated with higher long-term mortality in critically ill survivors
José António Lopes (2012)
Propensity-score matching in the cardiovascular surgery literature from 2004 to 2006: a systematic review and suggestions for improvement.
Peter C. Austin (2007)
Chronic dialysis and death among survivors of acute kidney injury requiring dialysis.
Ron Wald (2009)
Using Canadian Administrative Databases to Economic Data for Health Technology Assessments. Ottawa, Ontario: Canadian Agency for Drugs and Technologies
P Jacobs (2009)
Association between AKI and long-term renal and cardiovascular outcomes in United States veterans.
Lakhmir S. Chawla (2014)
Association between AKI, recovery of renal function, and long-term outcomes after hospital discharge.
Neesh I Pannu (2013)
Effects of the early administration of enalapril on mortality in patients with acute myocardial infarction. Results of the Cooperative New Scandinavian Enalapril Survival Study II (CONSENSUS II)
Karl Swedberg (1992)
Epidemiology and outcomes of acute renal failure in hospitalized patients: a national survey.
Orfeas Liangos (2006)
Validity of International Classification of Diseases, Ninth Revision, Clinical Modification Codes for Acute Renal Failure.
Sushrut S. Waikar (2006)
The magnitude of acute serum creatinine increase after cardiac surgery and the risk of chronic kidney disease, progression of kidney disease, and death.
Areef Ishani (2011)
Long-term risk of mortality and other adverse outcomes after acute kidney injury: a systematic review and meta-analysis.
Steven G Coca (2009)
Cardiovascular-Specific Mortality and Kidney Disease in Patients Undergoing Vascular Surgery.
Matthew Huber (2016)
Acute kidney injury associates with increased long-term mortality.
Jean-Philippe Lafrance (2010)
Elevated BP after AKI.
Chi-Yuan Hsu (2016)
Effect of ramipril on mortality and morbidity of survivors of acute myocardial infarction with clinical evidence of heart failure. The Acute Infarction Ramipril Efficacy (AIRE) Study Investigators
Gordon D. Murray (1993)
Valsartan, captopril, or both in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both.
Marc Pfeffer (2003)
A clinical trial of the angiotensin-converting-enzyme inhibitor trandolapril in patients with left ventricular dysfunction after myocardial infarction. Trandolapril Cardiac Evaluation (TRACE) Study Group.
Lars Køber (1995)
Acute Renal Failure Study Group. Epidemiology of acute renal failure: a prospective, multicenter, community-based study
F Liaño (1996)
Long-term risk of mortality and end-stage renal disease among the elderly after small increases in serum creatinine level during hospitalization for acute myocardial infarction.
Britt B. Newsome (2008)
A new equation to estimate glomerular filtration rate.
Andrew S. Levey (2009)
Overview of the Alberta Kidney Disease Network
Brenda R. Hemmelgarn (2009)
Renin angiotensin system blockade and cardiovascular outcomes in patients with chronic kidney disease and proteinuria: a meta-analysis.
Saravanan Balamuthusamy (2008)
The Effect of the Angiotensin-Converting–Enzyme Inhibitor Zofenopril on Mortality and Morbidity after Anterior Myocardial Infarction
Ettore Ambrosioni (1995)
Dialysis requirement, long-term major adverse cardiovascular events (MACE) and all-cause mortality in hospital acquired acute kidney injury (AKI): a propensity-matched cohort study
Bolanle A. Omotoso (2016)
Methods for identifying 30 chronic conditions: application to administrative data
Marcello Tonelli (2015)
The Impact of Acute Kidney Injury on the Long‐term Risk of Stroke
Vincent Wu (2014)
Long-term risk of coronary events after AKI.
Vin-Cent Wu (2014)
Acute kidney injury, mortality, length of stay, and costs in hospitalized patients.
Glenn M. Chertow (2005)
Analysis of acuity trends using Resource Intensity Weights via the CIHI Portal.
Liesje Sarnecki (2009)
Screening for, Monitoring, and Treatment of Chronic Kidney Disease Stages 1 to 3: A Systematic Review for the U.S. Preventive Services Task Force and for an American College of Physicians Clinical Practice Guideline
Howard A Fink (2012)
Acute and Chronic Kidney Disease and Cardiovascular Mortality After Major Surgery.
Tezcan Ozrazgat-Baslanti (2016)
Nephrologist follow-up improves all-cause mortality of severe acute kidney injury survivors.
Ziv Harel (2013)
Outcomes following diagnosis of acute renal failure in U.S. veterans: focus on acute tubular necrosis.
Richard L. Amdur (2009)
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
Francesco Lapi (2013)
Acute Kidney Injury in Patients Continued on Renin‐Angiotensin System Blockers During Hospitalization☆
Numan Alabdan (2017)
Cardiovascular-Specific Mortality and Kidney Disease in Patients Undergoing Vascular Surgery.
Matthew Huber (2016)
The Impact of Acute Kidney Injury on the Long‐term Risk of Stroke
Vin‐CentWu (2014)
The effect of the Angiotensin-Converting-Enzyme inhibitor Zofenopril on mortality after anterior myocardial infarction.
Ettore Ambrosioni (1995)
Validation of a case definition to define hypertension using administrative data.
Hude Quan (2009)
Dialysis-requiring acute renal failure increases the risk of progressive chronic kidney disease.
Lowell Lo (2009)
KDIGO Clinical Practice Guidelines for Acute Kidney Injury
Arif Khwaja (2012)
Acute Kidney Injury Recovery Pattern and Subsequent Risk of CKD: An Analysis of Veterans Health Administration Data.
Michael Heung (2016)
Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction. Results of the survival and ventricular enlargement trial. The SAVE Investigators.
Marc Pfeffer (1992)
Multicentre randomized controlled trial of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker withdrawal in advanced renal disease: the STOP-ACEi trial
Sunil Bhandari (2016)
Prediction of coronary heart disease using risk factor categories.
Peter W. F. Wilson (1998)
Acute kidney injury increases risk of ESRD among elderly.
Areef Ishani (2009)
Optimal caliper widths for propensity-score matching when estimating differences in means and differences in proportions in observational studies
Peter C. Austin (2011)

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Claire Francoz (2020)
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Matthew T. James (2020)
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Patrick Tran (2020)
Renin-Angiotensin System Blockade after Acute Kidney Injury: The Plot Thickens.
Steven Menez (2019)
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Nayan Arora (2020)
Longer predialysis ACEi/ARB utilization is associated with reduced postdialysis mortality.
Elvira O. Gosmanova (2020)
Stopping RAS Inhibitors to Minimize AKI: More Harm than Good?
Charles R V Tomson (2019)
Use of Angiotensin-Converting Enzyme Inhibitors/Angiotensin Receptor Blockers and Acute Kidney Disease after an Episode of AKI: A Multicenter Prospective Cohort Study
Abigail Hines (2020)
New Insights Into Mechanisms of Acute Kidney Injury in Heart Disease.
Sriram Sriperumbuduri (2019)
Prophylaxis and Management of Acute Kidney Injury
Yasuhiro Komatsu (2020)
Renin-angiotensin-aldosterone system blockers after KDIGO stage 3 acute kidney injury: use and impact on 2-year mortality in the AKIKI trial
Mathilde Scarton (2019)
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Steven G Coca (2020)
Akutes Nierenversagen: Bessere Prognose durch Hemmstoffe des Renin-Angiotensin-Systems?
Beate Schumacher (2019)
Renin-Angiotensin System Blockade after Acute Kidney Injury (AKI) and Risk of Recurrent AKI.
Chi-Yuan Hsu (2019)
Acute Kidney Injury and Regenerative Medicine
Yoshio Terada (2020)
Roadblocks and Opportunities to the Implementation of Novel Therapies for Acute Kidney Injury: A Narrative Review
Paraish S. Misra (2019)
Medication-Related Factors and Hospital Readmission in Older Adults with Chronic Kidney Disease
Wubshet Hailu Tesfaye (2019)
How Do We Navigate the Complexities Surrounding the Use of Angiotensin-Converting Enzyme Inhibitors/Angiotensin Receptor Blockers in Chronic Kidney Disease?
Sunil Bhandari Chadburn (2019)
Use of Renin Angiotensin System Blockers After Acute Kidney Injury: Balancing Tradeoffs.
Robert J. Alpern (2018)
Change in renal function associated with drug treatment in heart failure: national guidance
Andrew L Clark (2019)
Is the Renin-Angiotensin-Aldosterone System Good for the Kidney in Acute Settings?
Emmanuel Dudoignon (2019)
Fiend and friend in the renin angiotensin system: An insight on acute kidney injury.
Nisha Nandlal Sharma (2019)
Post-Acute Kidney Injury Proteinuria and Subsequent Kidney Disease Progression: The Assessment, Serial Evaluation, and Subsequent Sequelae in Acute Kidney Injury (ASSESS-AKI) Study.
Chi-Yuan Hsu (2020)
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