In patients with acute kidney injury (AKI), treatment with an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker (ACEI/ARB) is associated with a lower risk of death but an increased risk of kidney-related hospitalization, reports a study in JAMA Internal Medicine.
The study included 46,523 adults who had an episode of AKI in the hospital between 2008 and 2015, identified through the Alberta Kidney Disease Network database. All included patients survived to hospital discharge without end stage renal disease (ESRD). Mean age was 68.6 years; 52.8% of patients were men.
Forty-eight percent of patients were prescribed an ACEI or ARB within 6 months after hospital discharge. Mortality and secondary outcomes were compared for propensity score-matched groups of patients who did and did not receive ACEI/ARB treatment.
With at least 2 years’ follow-up, patients receiving an ACEI or ARB after AKI were at lower risk of death. Hazard ratio (HR) for mortality was 0.85, with adjustment for comorbid conditions, preadmission ACEI/ARB use, demographic factors, initial renal function, other factors related to hospitalization, and previous healthcare use. Both new and continued ACEI/ARB use were associated with lower mortality.
However, the ACEI/ARB group also had an increase in renal-related hospitalizations: adjusted HR 1.28. Major causes of hospitalization included acute renal failure, congestive heart failure, and hyperkalemia. Treatment with an ACEI/ARB after AKI was unrelated to the risk of progression to ESRD or doubling of serum creatinine.
Strategies are needed to reduce long-term mortality after AKI. These population-based data suggest that patients receiving ACEI/ARB therapy are at lower risk of death but higher risk of hospitalization for kidney-related causes. The researchers conclude, “These results suggest a potential benefit of ACEI or ARB use after AKI, but cautious monitoring for renal-specific complications may be warranted” [Brar S, et al. Association of angiotensin-converting enzyme inhibitor or angiotensin receptor blocker use with outcomes after acute kidney injury. JAMA Intern Med 2018; doi:10.1001/jamainternmed.2018.4749].