What is the clinical evidence from this study?

Study design: Cohort. Population: Acute Kidney Injury (AKI) (n=1285). Intervention: ACEIs/ARBs persistence vs. ACEIs/ARBs discontinuation. Primary outcome: 14-day AKI progression (OR 0.44, 95% CI 0.29-0.67, p=<0.001).

What question did this study set out to answer?

This study aims to explore the impact of ACEIs/ARBs on clinical outcomes in patients with acute kidney injury.

June 14, 2026Open Access

Association of ACEIs/ARBs treatment with clinical outcomes in acute kidney injury: a multicenter retrospective cohort analysis

Q: What are the key findings of this study?

Persistence of ACEIs/ARBs at the onset of acute kidney injury was associated with significantly lower odds of 14-day AKI progression compared to discontinuation (adjusted OR 0.44).

Q: What question did this study set out to answer?

This study aims to explore the impact of ACEIs/ARBs on clinical outcomes in patients with acute kidney injury.

Key Result

Persistence of ACEIs/ARBs at the onset of acute kidney injury was associated with significantly lower odds of 14-day AKI progression compared to discontinuation (adjusted OR 0.44).

Key Points

This study aims to explore the impact of ACEIs/ARBs on clinical outcomes in patients with acute kidney injury.
Multicenter retrospective cohort analysis involving 1,285 AKI patients.
Utilization patterns of ACEIs/ARBs categorized into discontinuation, persistence, and initiation.
Multivariate logistic regression and subgroup analyses used to assess associations.
Persistence of ACEIs/ARBs significantly associated with lower odds of 14-day AKI progression (adjusted OR 0.44, 95% CI 0.29–0.67, P < 0.001).
Unadjusted model showed inverse correlation between persistence of ACEIs/ARBs and 14-day mortality (OR 0.30, 95% CI 0.13–0.71, P = 0.006).
No significant differences in outcomes were noted between initiation and discontinuation groups across all models.

Study Design

Type

Cohort (n=1,285)

Multicenter

Yes

Structured PICO

Does persistence or initiation of ACEIs/ARBs improve 14-day AKI progression and mortality in patients with acute kidney injury compared to discontinuation?

Population

1,285 hospitalized adults aged ≥18 years with acute kidney injury, followed for 14 days to evaluate the association of ACEI/ARB utilization patterns with AKI progression and mortality.

Exposure

Persistence (n=657) or initiation (n=192) of ACEIs/ARBs

Comparator

Discontinuation of ACEIs/ARBs (n=436)

Outcome

14-day AKI progression and 14-day mortalityhard clinical

In patients with acute kidney injury, continuing ACEI/ARB therapy is associated with a reduced risk of 14-day AKI progression compared to discontinuation.

Main Result

Odds Ratio: 0.44 (95% CI 0.29–0.67)

Absolute Event Rate: 7% vs 16.06%

p-value: p=<0.001

Limitations

Selection bias from the original study screening method
Considerable residual confounding and confounding by indication
Lack of data on cumulative fluid balance, vasopressor needs, lactate levels, and physician reason for cessation
24-hour exposure period may not reflect real-world practices
Limited occurrence of events for 14-day mortality
Lack of generalizability for patients with baseline creatinine >4.0 mg/dL
Brief 14-day follow-up and intrinsic biases in EHR documentation

Abstract

ACEIs/ARBs (angiotensin-converting enzyme inhibitors/angiotensin receptor blockers) constituted the cornerstone of therapy for various cardiovascular and renal disorders. The appropriate management of ACEIs/ARBs in the acute kidney injury (AKI) remained controversial. In this multicenter study involving 1,285 AKI patients, we investigated the associations of ACEIs/ARBs discontinuation ( n = 436), persistence ( n = 657), and initiation ( n = 192) with 14-day AKI progression and mortality. Multivariate logistic regression analysis and subgroup analyses were conducted to evaluate the associations between ACEI/ARB utilization patterns and clinical outcomes. The persistence usage of ACEIs/ARBs was independently associated with lower odds of 14-day AKI progression compared to discontinuation (adjusted OR 0.44, 95% CI 0.29–0.67, P < 0.001) Regarding 14-day mortality, the persistence usage of ACEIs/ARBs exhibited an inverse correlation in the unadjusted model (OR 0.30, 95% CI 0.13–0.71, P = 0.006), but the association was attenuated after full adjustment model (OR 0.39, 95% CI 0.13–1.20, P = 0.101). No statistically significant differences in the risk of 14-day AKI progression or mortality were observed between the initiation and discontinuation cohorts across all models. In this retrospective cohort, the persistence of ACEI/ARB at the onset of AKI was associated with lower odds of 14-day progression, but not mortality. For the 14-day mortality, due to limited events, wide-ranging confidence intervals, and post-adjustment attenuation, these statistical instabilities need highly conservative interpretation and prospective validation. Not applicable.

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