Abstract: SA-PO029

Angiotensin 2 Receptor Blocker (ARB) and Angiotensin Converting Enzyme-Inhibitor (ACE) Therapy Indications and Risks in Patients Who Develop an AKI During Hospital Admission

Session Information

Category: Acute Kidney Injury

  • 003 AKI: Clinical and Translational

Authors

  • Humphrey, Toby, East and North Hertfordshire NHS Trust, Stevenage, United Kingdom
  • Shivakumar, Oshini, East and North Hertfordshire NHS Trust, Stevenage, United Kingdom
  • Berresford, Kate, East and North Hertfordshire NHS Trust, Stevenage, United Kingdom
  • Morlidge, Clare, East and North Hertfordshire NHS Trust, Stevenage, United Kingdom
  • Findlay, Andrew, East and North Hertfordshire NHS Trust, Stevenage, United Kingdom
  • Mathavakkannan, Suresh, East and North Hertfordshire NHS Trust, Stevenage, United Kingdom
Background

ACE/ARB are the second most prescribed medicine from primary care in England. Despite an aged and co-morbid population prescription of ACE/ARB is increasing. There are defined benefits for patients on ACE/ARB in certain clinical situations but there is concern in frail, elderly patients at risk of AKI. We sought to review the indications and risk factors for ACE/ARB use in patients (prescribed ACE/ARB in the community) who developed AKI during admission to a 700 bed secondary care hospital.

Methods

Adult elective and non-elective patients who developed AKI during an admission episode in February to April 2016 were identified by electronic AKI alert. 311 AKI events were reviewed by an AKI specialist nurse over this time period. Demographic details and medications including ACE/ARB were documented. All AKI patients admitted on ACE/ARB therapy had retrospective searches of their co-morbidities and indications for ACE/ARB therapy on electronic patient record and pathology database.

Results

311 AKI events were reviewed by the AKI nurse between February - April 2016. 102 /311 (32.8%) of those patients had been prescribed ACE/ARB therapy up until admission. Of those 102 patients (M:F, 52:50), the mean age was 81.44 years, median age adjusted Charlson Co-Morbidity score was 6. 65 patients (63.73%) had a prior history of AKI whilst only 38 patients (37.25%) had a diagnosis of type 2 Diabetes, 24 (23.53%) had heart failure diagnosed by echocardiogram, 17 patients (16.67%) had documented proteinuria prior to admisison, 34 (33.33%) had a prior history of ischaemic heart disease. 13 patients (12.75%) had a diagnosis of cancer and 24 (23.53%) had a diagnosis of dementia.

Conclusion

Our data indicates patients on ACE/ARB therapy who develop an AKI during hospital episode are frequently elderly and co-morbid with a high likelihood of previous AKI. They frequently do not have good indications for ACE/ARB therapy with few diabetics, few diagnoses of cardiac failure, ischaemic heart disease and proteinuria.This data should be used to support further studies to identify elderly patient populations in the community prescribed ACE/ARB therapy who may benefit from rationalisation of their medication.