Key result
Creatinine increases ≥30% after starting ACEI/ARBs were associated with increased risks of end stage renal disease (IRR 3.43; 95% CI 2.40-4.91), myocardial infarction, heart failure, and death.
Why the study?
Does a serum creatinine increase of ≥30% after starting ACEi/ARB treatment predict end stage renal disease, myocardial infarction, heart failure, and death in patients starting ACEi/ARB therapy?
Population
122,363 patients starting treatment with angiotensin converting enzyme inhibitors or angiotensin receptor…
Comparison
Creatinine increases of ≥30% after starting… vs Creatinine increases of <30% after starting…
Design
Cohort
Authors
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Creatinine rises ≥30% after ACEI/ARB initiation may flag higher cardiorenal risk; leaves open whether the guideline threshold warrants revision.
Cohort (n=122,363)
Yes
Does a serum creatinine increase of ≥30% after starting ACEi/ARB treatment predict end stage renal disease, myocardial infarction, heart failure, and death in patients starting ACEi/ARB therapy?
Effect estimate: IRR 3.43 for end stage renal disease (95% CI 2.40-4.91)
Increases in serum creatinine after initiating ACEi/ARB therapy are associated with a graduated increase in the risk of adverse cardiorenal outcomes and death, challenging the safety of the current guideline-recommended 30% threshold for stopping treatment.
Schmidt et al. (2017) conducted a cohort in Patients starting treatment with angiotensin converting enzyme inhibitors or angiotensin receptor blockers (n=122,363). Creatinine increase ≥30% after starting ACEI/ARB vs. Creatinine increase <30% was evaluated on end stage renal disease, myocardial infarction, heart failure, and death (IRR 3.43 for end stage renal disease, 95% CI 2.40-4.91). Creatinine increases ≥30% after starting ACEI/ARBs were associated with increased risks of end stage renal disease (IRR 3.43; 95% CI 2.40-4.91), myocardial infarction, heart failure, and death.
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