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).
Cohort (n=1,285)
Yes
Does persistence or initiation of ACEIs/ARBs improve 14-day AKI progression and mortality in patients with acute kidney injury compared to discontinuation?
In patients with acute kidney injury, continuing ACEI/ARB therapy is associated with a reduced risk of 14-day AKI progression compared to discontinuation.
Odds Ratio: 0.44 (95% CI 0.29–0.67)
Absolute Event Rate: 7% vs 16.06%
p-value: p=<0.001
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.
Wang et al. (2026) conducted a cohort in Acute Kidney Injury (AKI) (n=1,285). ACEIs/ARBs persistence vs. ACEIs/ARBs discontinuation was evaluated on 14-day AKI progression (OR 0.44, 95% CI 0.29-0.67, p=<0.001). 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).