Prospective Cohort Study of Renin-Angiotensin System Blocker Usage after Hospitalized Acute Kidney Injury.
Acute Kidney Injury
/ epidemiology
Aged
Angiotensin Receptor Antagonists
/ therapeutic use
Angiotensin-Converting Enzyme Inhibitors
/ therapeutic use
Disease Progression
Female
Heart Failure
/ epidemiology
Hospitalization
/ statistics & numerical data
Humans
Kidney Diseases
/ physiopathology
Male
Middle Aged
Mortality
Proportional Hazards Models
Prospective Studies
Recurrence
Renin-Angiotensin System
Risk Assessment
Risk Factors
acute kidney injury
acute renal failure
epidemiology and outcomes
renin angiotensin system
Journal
Clinical journal of the American Society of Nephrology : CJASN
ISSN: 1555-905X
Titre abrégé: Clin J Am Soc Nephrol
Pays: United States
ID NLM: 101271570
Informations de publication
Date de publication:
31 12 2020
31 12 2020
Historique:
received:
03
07
2020
accepted:
05
10
2020
pubmed:
5
12
2020
medline:
15
12
2021
entrez:
4
12
2020
Statut:
ppublish
Résumé
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. 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. 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 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.
Sections du résumé
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
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.
Identifiants
pubmed: 33272913
pii: 01277230-202101000-00007
doi: 10.2215/CJN.10840720
pmc: PMC7792656
doi:
Substances chimiques
Angiotensin Receptor Antagonists
0
Angiotensin-Converting Enzyme Inhibitors
0
Types de publication
Journal Article
Multicenter Study
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
26-36Subventions
Organisme : NIDDK NIH HHS
ID : R01 DK114014
Pays : United States
Organisme : NIDDK NIH HHS
ID : R03 DK111881
Pays : United States
Organisme : NIDDK NIH HHS
ID : R01 DK098233
Pays : United States
Organisme : NIDDK NIH HHS
ID : U01 DK082192
Pays : United States
Organisme : NIDDK NIH HHS
ID : K24 DK113381
Pays : United States
Organisme : NIDDK NIH HHS
ID : U01 DK084012
Pays : United States
Organisme : NIDDK NIH HHS
ID : K23 DK117065
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR001863
Pays : United States
Organisme : NIDDK NIH HHS
ID : U01 DK082183
Pays : United States
Organisme : NIDDK NIH HHS
ID : U01 DK082223
Pays : United States
Organisme : NIDDK NIH HHS
ID : R01 DK101507
Pays : United States
Organisme : NIDDK NIH HHS
ID : U01 DK082185
Pays : United States
Organisme : NIDDK NIH HHS
ID : K24 DK092291
Pays : United States
Investigateurs
Nasrollah Ghahramani
(N)
W Brian Reeves
(WB)
Lan Kong
(L)
Ming Wang
(M)
Elana Farace
(E)
Thida Tan
(T)
Juan D Ordonez
(JD)
Sijie Zheng
(S)
Julia B Lewis
(JB)
Dennis G Moledina
(DG)
Prasad Devarajan
(P)
Michael Zappitelli
(M)
Mark Wurfel
(M)
Paul W Eggers
(PW)
Marva M Moxey-Mims
(MM)
Informations de copyright
Copyright © 2021 by the American Society of Nephrology.
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