AKI: postdischarge ACEI, ARB tied to lower mortality

  • Brar S & al.
  • JAMA Intern Med
  • 1 Dec 2018

  • curated by Yael Waknine
  • Clinical Essentials
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Takeaway

  • 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.

Study design

  • 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.

Key results

  • 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.

Limitations

  • Observational, retrospective design.
  • Adherence not captured.

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