- Angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) after discharge for acute kidney injury (AKI) is associated with lower mortality but greater odds of kidney-related hospitalization.
Why this matters
- ACEI/ARB use warrants close monitoring for kidney-specific complications.
- Alberta Kidney Disease Network data for 46,253 hospitalized adults (mean age, 68.6 years; 52.8% male) with AKI, followed for ≥2 years.
- Outcomes evaluated for 9456 propensity-matched pairs who did/did not receive ACEI/ARB within 6 months of discharge.
- Funding: Canadian Institute of Health Research.
- 48.0% received new ACEI/ARB script within 6 months of hospitalization, and 41.1% continued prior use.
- Multivariate analysis showed lower mortality after 2 years in new (aHR=0.85; 95% CI, 0.78-0.93) and continuing (aHR=0.77; 95% CI, 0.73-0.80) ACEI/ARB users.
- An increased risk for kidney-related hospitalization was observed among new (aHR=1.32; 95% CI, 1.03-1.69) and continuing ACEI/ARB users (aHR=1.34; 95% CI, 1.16-1.55).
- Most common causes were acute renal failure (aHR=1.25; 95% CI, 1.08-1.46) and hyperkalemia (aHR=1.56; 95% CI, 1.07-2.27).
- No association with progression to end-stage renal disease.
- Observational, retrospective design.
- Adherence not captured.