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Kidney Week

Abstract: FR-PO024

Renin-Angiotensin System Blockade After AKI and Risk of Recurrent AKI

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Hsu, Chi-yuan, UCSF, San Francisco, California, United States
  • Liu, Kathleen D., UCSF, San Francisco, California, United States
  • Yang, Jingrong, Kaiser Permanente Northern California, Oakland, California, United States
  • Glidden, David V., UCSF, San Francisco, California, United States
  • Tan, Thida C., Kaiser Permanente Northern California, Oakland, California, United States
  • Pravoverov, Leonid, Kaiser Permanente Northern California, Oakland, California, United States
  • Zheng, Sijie, Kaiser Permanente Northern California, Oakland, California, United States
  • Go, Alan S., Kaiser Permanente Northern California, Oakland, California, United States
Background

How to best medically manage patients who survived hospitalized acute kidney injury (AKI) is unclear. These patients are at higher risk of further loss of renal function so angiotenin converting enzyme inhibitors (ACE-I) or angiotensin receptor blockers (ARB) may be reno-protective. However, recurrent AKI is common and use of ACE-I/ARB in this setting may increase risk of recurrent AKI.

Methods

This is a retrosepctive cohort study of 10,242 members of an integrated healthcare delivery system in Northern California who experienced AKI and survived a hospitalization between January 1, 2006 and December 31, 2013. All study participants did not have prior heart failure or previous use of ACE-I or ARB therapy up to five years prior. New receipt of ACE-I/ARB was identified based on dispensed prescriptions found in outpatient health plan pharmacy databases. The pirmary outcome of interest was subsequent episode of hospitalized AKI after discharge from an initial index hospitalization complicated by AKI. Recurrent AKI episode was defined using acute changes in serum creatinine concentrations. Marginal structural models (MSM) were used to adjust for baseline and potential time-dependent confounders.

Results

During follow-up, we observed 22.0 episodes of recurrent AKI/100 person-years while taking ACE-I/ARB (95% CI: 20.5 to 23.6 episodes per 100 person-years) compared to 14.1 episodes/100 person-years while not receiving ACE-I/ARB (95% CI: 13.7 to 14.5 episodes per 100 person-years). However, in MSM causal inference models that adjusted for baseline and potential time-dependent confounders, exposure to ACE-I or ARB use was not associated with higher incidence of recurrent AKI (adjusted odds ratio 0.71, 95% CI: 0.45 to 1.12).

Conclusion

Our study provided reassuring data about the safety of initiating ACE-I or ARB after an episode of AKI.

Funding

  • NIDDK Support