Sandeep Brar1, Kathleen D Liu2, Alan S Go3,4, Raymond K Hsu5, Vernon M Chinchilli6, Steven G Coca7, Amit X Garg8, Jonathan Himmelfarb9, T Alp Ikizler10, James Kaufman11, Paul L Kimmel12, Chirag R Parikh13, Edward D Siew10,14, Lorraine B Ware15, Hui Zeng6, Chi-Yuan Hsu5,4. 1. Department of Epidemiology and Biostatistics, University of California, San Francisco, California. 2. Departments of Medicine and Anesthesia, University of California, San Francisco, California. 3. Division of Nephrology, University of California, San Francisco School of Medicine, San Francisco, California. 4. Division of Research, Kaiser Permanente Northern California, Oakland, California. 5. Division of Nephrology, University of California, San Francisco School of Medicine, San Francisco, California chi-yuan.hsu@ucsf.edu. 6. Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania. 7. Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, New York. 8. Department of Medicine, Epidemiology and Biostatistics, Western University, London, Ontario, Canada. 9. Division of Nephrology, University of Washington, Seattle, Washington. 10. Division of Nephrology and Hypertension and Vanderbilt Center for Kidney Disease, Vanderbilt University Medical Center, Nashville, Tennessee. 11. Renal Section, Veterans Affairs New York Harbor Healthcare System and New York University School of Medicine, New York, New York. 12. Division of Kidney, Urologic and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland. 13. Division of Nephrology, Johns Hopkins School of Medicine, Baltimore, Maryland. 14. Tennessee Valley Health Services Nashville Veterans Affairs Hospital, Nashville, Tennessee. 15. Departments of Medicine and Pathology, Microbiology and Immunology, Vanderbilt University, Nashville, Tennessee.
Abstract
BACKGROUND AND OBJECTIVES: The risk-benefit ratio of angiotensin-converting enzyme inhibitor or angiotensin receptor blocker therapy after AKI may be altered due to concerns regarding recurrent AKI. We evaluated, in a prospective cohort, the association between use (versus nonuse) of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and the subsequent risk of AKI and other adverse outcomes after hospitalizations with and without AKI. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We studied 1538 patients recently discharged from the hospital who enrolled in the multicenter, prospective ASSESS-AKI study, with approximately half of patients experiencing AKI during the index hospitalization. All participants were seen at a baseline visit 3 months after their index hospitalization and were categorized at that time on whether they were using angiotensin-converting enzyme inhibitors/angiotensin receptor blockers or not. We used multivariable Cox regression, adjusting for demographics, comorbidities, eGFR, urine protein-creatinine ratio, and use of other medications, to examine the association between angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use and subsequent risks of AKI, death, kidney disease progression, and adjudicated heart-failure events. RESULTS: The use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers was 50% (386/769) among those with AKI during the index hospitalization and 47% (362/769) among those without. Among those with AKI during the index hospitalization, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use was not associated with a higher risk of recurrent hospitalized AKI (adjusted hazard ratio, 0.88; 95% confidence interval, 0.69 to 1.13). Associations between angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use and death, kidney disease progression, and adjudicated heart-failure events appeared similar in study participants who did and did not experience AKI during the index hospitalization (all interaction P values >0.05). CONCLUSIONS: The risk-benefit ratio of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker therapy after hospital discharge appears to be similar regardless of whether AKI occurred during the hospitalization.
BACKGROUND AND OBJECTIVES: The risk-benefit ratio of angiotensin-converting enzyme inhibitor or angiotensin receptor blocker therapy after AKI may be altered due to concerns regarding recurrent AKI. We evaluated, in a prospective cohort, the association between use (versus nonuse) of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and the subsequent risk of AKI and other adverse outcomes after hospitalizations with and without AKI. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We studied 1538 patients recently discharged from the hospital who enrolled in the multicenter, prospective ASSESS-AKI study, with approximately half of patients experiencing AKI during the index hospitalization. All participants were seen at a baseline visit 3 months after their index hospitalization and were categorized at that time on whether they were using angiotensin-converting enzyme inhibitors/angiotensin receptor blockers or not. We used multivariable Cox regression, adjusting for demographics, comorbidities, eGFR, urine protein-creatinine ratio, and use of other medications, to examine the association between angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use and subsequent risks of AKI, death, kidney disease progression, and adjudicated heart-failure events. RESULTS: The use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers was 50% (386/769) among those with AKI during the index hospitalization and 47% (362/769) among those without. Among those with AKI during the index hospitalization, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use was not associated with a higher risk of recurrent hospitalized AKI (adjusted hazard ratio, 0.88; 95% confidence interval, 0.69 to 1.13). Associations between angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use and death, kidney disease progression, and adjudicated heart-failure events appeared similar in study participants who did and did not experience AKI during the index hospitalization (all interaction P values >0.05). CONCLUSIONS: The risk-benefit ratio of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker therapy after hospital discharge appears to be similar regardless of whether AKI occurred during the hospitalization.
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Authors: Ian McCoy; Sandeep Brar; Kathleen D Liu; Alan S Go; Raymond K Hsu; Vernon M Chinchilli; Steven G Coca; Amit X Garg; Jonathan Himmelfarb; T Alp Ikizler; James Kaufman; Paul L Kimmel; Julie B Lewis; Chirag R Parikh; Edward D Siew; Lorraine B Ware; Hui Zeng; Chi-Yuan Hsu Journal: BMC Nephrol Date: 2021-07-29 Impact factor: 2.388