ACEI/ARB treatment during an episode of acute kidney injury in critically ill patients significantly reduced the risk of ICU mortality (HR 0.34) but increased the risk of acute kidney disease.
Observational (n=19,074)
No
Does ACEI/ARB therapy reduce mortality in critically ill patients with acute kidney injury?
In critically ill patients with acute kidney injury, the administration of ACEIs or ARBs during the ICU stay is associated with significantly lower short- and long-term mortality, despite an increased risk of acute kidney disease.
Effect estimate: HR 0.34 (95% CI 0.27-0.42)
Absolute Event Rate: 3.59% vs 8.65%
Background: The safety of prescribing angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) during acute kidney injury (AKI) remains unclear. We aimed to investigate the associations of ACEI/ARB therapy in AKI with the risk of mortality, acute kidney disease (AKD), and hyperkalemia. Methods: We conducted a retrospective monocentric study, which included patients in Massachusetts between 2008 and 2019 from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Propensity score matching was performed for the endpoint analysis. The association between ACEI/ARB therapy and mortality was assessed using Cox proportional hazards regression models. Logistic regression was used to assess the risk of AKD and hyperkalemia. Results: Among the 19,074 individuals with AKI admitted to the intensive care unit (ICU), 3,244 (17.0%) received ACEI/ARBs, while 15,830 (83.0%) did not. In the propensity score-matched sample of 6,358 individuals, we found a decreased risk of mortality in those who received ACEI/ARBs compared to those who did not (hazard ratio HR for ICU mortality: 0.34, 95% confidence interval CI: 0.27–0.42); HR for in-hospital mortality: 0.47, 95% CI: 0.39–0.56; HR for 30-day mortality: 0.47, 95% CI: 0.40–0.56; HR for 180-day mortality: 0.53, 95% CI: 0.45–0.62). However, the use of ACEI/ARBs was associated with a higher risk of AKD (risk ratio RR: 1.81; 95% CI: 1.55–2.12). There was no significant association between ACEI/ARBs and an increased risk of hyperkalemia (RR: 1.21; 95% CI: 0.96–1.51). Conclusions: ACEI/ARB treatment during an episode of AKI may decrease all-cause mortality, but increases the risk of AKD. Future randomized controlled trials are warranted to validate these findings.
Zhu et al. (Mon,) conducted a observational in Acute kidney injury in critically ill patients (n=19,074). Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) vs. No ACEI/ARB therapy was evaluated on ICU mortality (HR 0.34, 95% CI 0.27-0.42). ACEI/ARB treatment during an episode of acute kidney injury in critically ill patients significantly reduced the risk of ICU mortality (HR 0.34) but increased the risk of acute kidney disease.