Association of angiotensin-converting enzyme inhibitor or angiotensin receptor blocker use with outcomes after acute kidney injury

JAMA Dec 06, 2018

Brar S, et al. - Using data from the Alberta Kidney Disease Network population database, researchers conducted this retrospective cohort study to assess whether the use of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) after hospital discharge is correlated with better results in patients with acute kidney injury (AKI). According to results, ACEI or ARB therapy seemed to be related to lower mortality but a higher risk of hospitalization for a renal cause among patients with AKI. A potential benefit of ACEI or ARB use after AKI was suggested, but careful monitoring for renal-specific complications might be warranted.

Methods

  • Study participants included 46,253 adults with an episode of AKI during a hospitalization between July 1, 2008, and March 31, 2015, in Alberta, Canada.
  • All patients who survived the hospital discharge have been followed up for ≥ 2 years.
  • Use of an ACEI or ARB within 6 months after hospital discharge was the included main exposure.
  • Mortality was the primary outcome.
  • Hospitalization for a renal cause, end-stage renal disease (ESRD), and a composite outcome of ESRD or sustained doubling of serum creatinine concentration were included secondary outcomes.
  • Researchers defined AKI as a 50% increase between prehospital and peak in-hospital serum creatinine concentrations.
  • They used propensity scores 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

  • In total, 22,193 (48.0%) participants were prescribed an ACEI or ARB within 6 months of discharge.
  • After adjustment for comorbidities, use of ACEI or ARB prior to admission, demographics, baseline kidney function, other factors related to index hospitalization, and prior health-care services, use of ACEI or ARB was linked to lower mortality in AKI patients after 2 years (adjusted hazard ratio, 0.85; 95% CI, 0.81-0.89).
  • Patients receiving ACEI or ARB, however, had a higher risk of hospitalization for a renal cause (adjusted hazard ratio, 1.28; 95% CI, 1.12-1.46).
  • There was no association between the use of ACEI or ARB and progression to ESRD.
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