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Kidney Week

Abstract: TH-PO064

Routine Laboratory Monitoring Following Initiation of an ACEi or ARB and the Association with Adverse Outcomes

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Nash, Danielle Marie, McMaster University, Hamilton, Ontario, Canada
  • Parikh, Rishi V., Kaiser Permanente Northern California, Oakland, California, United States
  • Garg, Amit X., Western University, London, Ontario, Canada
  • Go, Alan S., Kaiser Permanente Northern California, Oakland, California, United States
Background

Clinical guidelines recommend serum creatinine and potassium monitoring shortly after initiating an Angiotensin Converting Enzyme Inhibitor (ACEi) or Angiotensin Receptor Blocker (ARB). However, it is unclear if monitoring prevents adverse outcomes. The objective of this study was to identify the association between obtaining laboratory monitoring shortly after initiating an ACEi or ARB prescription and adverse outcomes across two large North American regions.

Methods

We conducted two population-based retrospective cohort studies using healthcare data from Kaiser Permanente Northern California and the Institute for Clinical Evaluative Sciences, Ontario, Canada. We included patients initiating an ACEi or ARB prescription between 2007 and 2015. We compared patients with both outpatient serum creatinine and potassium tests in the 30 days following the prescription date to a group without such tests, where we randomly assigned a test date. Patients with and without follow-up tests were matched using high dimensional propensity scores to have similar indicators of baseline health. We assessed outcomes of all-cause mortality and hospitalization with acute kidney injury or hyperkalemia within 30 days of the test date using Cox proportional hazards regression.

Results

In the Kaiser cohort, 55,487 (34%) eligible patients received follow-up outpatient serum creatinine and potassium tests (mean 12 days after ACEi / ARB initiation). The final cohort included 54,274 patients with follow-up tests matched to 54,274 without tests (mean age 63 years). There was no significant difference in 30-day all-cause mortality between patients with follow-up tests compared to patients without tests (see Table). Patients with follow-up tests were more likely to be hospitalized with acute kidney injury, but not hyperkalemia, compared to patients without tests. The findings were similar in the Ontario cohort (mean age 75 years).

Conclusion

Routinely measuring serum creatinine and potassium after initiation of an ACEi or ARB does not appear to prevent adverse outcomes compared to no such measurements.

OutcomeKaiser Permanente Northern California CohortOntario Cohort
Follow-up test, n (%)No follow-up tests, n (%)Hazard Ratio (HR) (95% CI)Adjusted HR (95% CI)Follow-up tests, n (%)No follow-up tests, n (%)HR (95% CI)Adjusted HR (95% CI)
All-cause mortality85 (0.16)108 (0.20)0.78 (0.59-1.03)0.70 (0.46-1.06)144 (0.24)111 (0.19)1.29 (1.01-1.66)1.20 (0.86-1.66)
Hospitalization with acute kidney injury93 (0.17)52 (0.09)1.82 (1.30-2.57)2.44 (1.40-4.26)60 (0.67)26 (0.29)2.23 (1.41-3.54)4.86 (1.56-15.17)
Hospitalization with hyperkalemia22 (0.04)11 (0.02)2.00 (0.97-4.12)N/A*14 (0.16)9 (0.10)1.56 (0.67-3.59)N/A*

*Adjusted models did not converge

Funding

  • Government Support - Non-U.S.