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.
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?
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.
Effect estimate: IRR 3.43 for end stage renal disease (95% CI 2.40-4.91)
Objective To examine long term cardiorenal outcomes associated with increased concentrations of creatinine after the start of angiotensin converting enzyme inhibitor/angiotensin receptor blocker treatment. Design Population based cohort study using electronic health records from the Clinical Practice Research Datalink and Hospital Episode Statistics. Setting UK primary care, 1997-2014. Participants Patients starting treatment with angiotensin converting enzyme inhibitors or angiotensin receptor blockers (n=122 363). Main outcome measures Poisson regression was used to compare rates of end stage renal disease, myocardial infarction, heart failure, and death among patients with creatinine increases of 30% or more after starting treatment against those without such increases, and for each 10% increase in creatinine. Analyses were adjusted for age, sex, calendar period, socioeconomic status, lifestyle factors, chronic kidney disease, diabetes, cardiovascular comorbidities, and use of other antihypertensive drugs and non-steroidal anti-inflammatory drugs. Results Among the 2078 (1.7%) patients with creatinine increases of 30% or more, a higher proportion were female, were elderly, had cardiorenal comorbidity, and used non-steroidal anti-inflammatory drugs, loop diuretics, or potassium sparing diuretics. Creatinine increases of 30% or more were associated with an increased adjusted incidence rate ratio for all outcomes, compared with increases of less than 30%: 3.43 (95% confidence interval 2.40 to 4.91) for end stage renal disease, 1.46 (1.16 to 1.84) for myocardial infarction, 1.37 (1.14 to 1.65) for heart failure, and 1.84 (1.65 to 2.05) for death. The detailed categorisation of increases in creatinine concentrations (Conclusions Increases in creatinine after the start of angiotensin converting enzyme inhibitor/angiotensin receptor blocker treatment were associated with adverse cardiorenal outcomes in a graduated relation, even below the guideline recommended threshold of a 30% increase for stopping treatment.
Schmidt et al. (Thu,) 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.