Stopping ACEI/ARB after acute kidney injury not associated with adverse outcomes

  • Bidulka P & al.
  • BMC Med
  • 29 Jul 2020

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • In both England and Sweden, there was no evidence of an increased risk of admissions for heart failure (HF), acute kidney injury (AKI) or stroke among people who stopped angiotensin-converting enzyme inhibitors (ACEI)/angiotensin II receptor blockers (ARB) treatment after hospitalisation for AKI vs those who continued.      

Why this matters

  • Physicians can be assured that restarting ACEI/ARB treatment in people with evidence-based indications for long-term treatment after discharge with AKI is not associated with harm.

Study design

  • Researchers conducted two parallel population-based cohort studies in English (n=8566) and Swedish (n=2024) primary and secondary care, 2006-2016.
  • The risks of admission with heart failure (primary analysis), AKI, stroke or death within 2 years after AKI hospitalisation were compared in people who stopped ACEI/ARB treatment vs those who continued.
  • Funding: None disclosed.

Key results

  • In the primary analysis, 55% (4003/7303) and 69% (1235/1790) of people with AKI hospitalisation following recent ACEI/ARB therapy were classified as stopping ACEI/ARB based on no issued prescription within 30 days of discharge in England and Sweden, respectively.
  • In England, people who stopped ACEI/ARB vs those who continued showed no difference in the risk of HF (adjusted HR [aHR], 1.10; 95% CI, 0.93-1.30), AKI (aHR, 0.90; 95% CI, 0.77-1.05) and stroke (aHR, 0.99; 95% CI 0.71-1.38).
  • There was an increased risk of death in those who stopped ACEI/ARB vs those who continued (aHR, 1.27; 95% CI, 1.15-1.41).
  • Similar results were seen in Sweden: people who stopped ACEI/ARB vs those who continued showed no difference in the risk of HF (aHR, 0.91; 95% CI, 0.73-1.13) and AKI (aHR, 0.81; 95% CI, 0.54-1.21).
  • However, no increased risk of death (aHR, 0.94; 95% CI, 0.78-1.13) and a lower risk of stroke (aHR, 0.56; 95% CI, 0.34-0.93) was seen in people who stopped ACEI/ARB.

Limitations

  • Risk of residual confounding.