Key result
New ACE-I/ARB use in AKI survivors without heart failure is not linked to recurrent hospitalized AKI.
Why the study?
Optimal medical management after surviving hospitalized AKI is unclear, and using renin-angiotensin system blockers may increase the risk of recurrent AKI.
Does new use of ACE-Is/ARBs increase the risk of recurrent hospitalized AKI in AKI survivors without heart failure?
Cohort (n=10,242)
Does new use of ACE-Is/ARBs increase the risk of recurrent hospitalized AKI in AKI survivors without heart failure?
In AKI survivors without heart failure, initiating ACE-I/ARB therapy does not appear to increase the risk of recurrent hospitalized AKI.
BACKGROUND AND OBJECTIVES: How to best medically manage patients who survived hospitalized AKI is unclear. Use of renin-angiotensin system blockers in this setting may increase risk of recurrent AKI. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This is a cohort study of 10,242 members of an integrated health care delivery system in Northern California who experienced AKI and survived a hospitalization between January 1, 2006 and December 31, 2013. All study participants did not have prior heart failure or use of angiotensin-converting enzyme inhibitors (ACE-Is) or angiotensin receptor blockers (ARBs) up to 5 years prior. New receipt and time-updated exposure of ACE-Is/ARBs was identified on the basis of dispensed prescriptions found in outpatient health plan pharmacy databases. The main outcome of interest was subsequent episode of hospitalized AKI after discharge from an initial index hospitalization complicated by AKI. Recurrent AKI episode was defined using acute changes in serum creatinine concentrations. Marginal structural models were used to adjust for baseline and potential time-dependent confounders. RESULTS: or documented proteinuria before hospitalization. With a median of 3 (interquartile range, 1-5) years of follow-up, 1853 (18%) patients initiated use of ACE-Is/ARBs and 2124 (21%) patients experienced recurrent AKI. Crude rate of recurrent AKI was 6.1 (95% confidence interval [95% CI], 5.9 to 6.4) per 100 person-years off ACE-Is/ARBs and 5.7 (95% CI, 4.9 to 6.5) per 100 person-years on ACE-Is/ARBs. In marginal structural causal inference models that adjusted for baseline and potential time-dependent confounders, exposure to ACE-I/ARB use was not associated with higher incidence of recurrent AKI (adjusted odds ratio, 0.71; 95% CI, 0.45 to 1.12). CONCLUSIONS: In this study of AKI survivors without heart failure, new use of ACE-I/ARB therapy was not independently associated with increased risk of recurrent hospitalized AKI.
No takes yet. Share an insight, caveat, or question.
Hsu et al. (2019) conducted a cohort in Acute Kidney Injury (n=10,242). ACE-Is/ARBs vs. No ACE-Is/ARBs was evaluated on Subsequent episode of hospitalized AKI (adjusted OR 0.71, 95% CI 0.45 to 1.12). New use of ACE-I/ARB therapy in AKI survivors without heart failure was not associated with a higher incidence of recurrent hospitalized AKI (adjusted OR 0.71; 95% CI 0.45-1.12).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: