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ACEI or ARB Use After Acute Kidney Injury
Study Questions:
What is the impact of use of an angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) with outcomes after hospitalization in patients with acute kidney injury (AKI)?
Methods:
The investigators used data from the Alberta Kidney Disease Network population database for a retrospective cohort study 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. The exposure of interest was use of an ACEI or ARB within 6 months after hospital discharge. 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 [standard deviation] 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% confidence interval [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:
The authors concluded that 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.
Perspective:
This study reports that patients with AKI treated with an ACEI or ARB after the index hospitalization had a lower risk of death. However, ACEI or ARB use was also associated with an increased risk of hospitalization for a renal cause, primarily for acute renal failure and hyperkalemia, but with no increase in ESRD. Overall results are consistent with the FROG-ICU study (ClinicalTrials.gov Identifier: NCT01367093), which reported that in patients with AKI, ACEI/ARB prescription at discharge was associated with a decrease in 1-year mortality. These observations require further evaluation in prospective studies evaluating postdischarge care strategies for patients with AKI to specifically assess whether treatment with an ACEI or ARB in patients with AKI improves long-term outcomes.
Clinical Topics: Diabetes and Cardiometabolic Disease, Prevention
Keywords: Acute Kidney Injury, Angiotensin-Converting Enzyme Inhibitors, Angiotensin Receptor Antagonists, Creatinine, Hospitalization, Hyperkalemia, Kidney Failure, Chronic, Metabolic Syndrome, Outcome Assessment, Health Care, Primary Prevention
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