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Abstract: SA-OR020

ACE-I/ARB Use and Outcomes After Hospitalized AKI

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Brar, Sandeep, University of California San Francisco, San Francisco, California, United States
  • Liu, Kathleen D., University of California at San Francisco School of Medicine, San Francisco, California, United States
  • Go, Alan S., Kaiser Permanente Northern California, Oakland, California, United States
  • Hsu, Raymond K., University of California, San Francisco, San Francisco, California, United States
  • Chinchilli, Vernon M., Penn State College of Medicine, Hershey, Pennsylvania, United States
  • Kimmel, Paul L., National Institute of Diabetes and Digestive Kidney Diseases (NIDDK), Bethesda, Maryland, United States
  • Kaufman, James S., VA New York Harbor Healthcare System, New York, New York, United States
  • Hsu, Chi-yuan, University of California San Francisco, San Francisco, California, United States

Group or Team Name

  • ASSESS-AKI study investigators
Background

The risk-benefit ratio of ACE-I/ARB therapy after an AKI episode is unclear.

Methods

We studied 1570 patients recently discharged from hospital and enrolled in a multi-center prospective cohort study (ASSESS-AKI). Follow-up began 3 months after index hospitalization and continued through November 2018. Half of the participants had AKI during the index hospitalization. ACE-I/ARB use and covariates were ascertained 3 months after discharge from the index hospitalization. We used multivariable Cox regression adjusting for demographics, cardiovascular disease, diabetes mellitus, heart failure (HF), blood pressure, urine protein to creatinine ratio, and eGFR to examine the association between ACE-I/ARB use and subsequent death, AKI (≥50% difference between peak and nadir inpatient serum creatinine), renal progression (ESRD or halving of eGFR), and adjudicated HF events.

Results

Among study participants who did not have AKI during index hospitalization (N=806), mean age was 65 years, mean eGFR 74 ml/min/1.73m2, and 45% self-reported use of ACE-I/ARB 3 months after hospitalization. Among study participants who did have AKI during index hospitalization (N=764), mean age was 64 years, mean eGFR 65 ml/min/1.73m2, and 50% self-reported use of ACE-I/ARB 3 months after hospitalization. Mean follow-up time was 3.6 years. ACE-I/ARB therapy 3 months after an AKI hospitalization was associated with a lower risk of another hospitalized AKI event and a lower risk of death (Table).

Conclusion

Use of ACE-I/ARB in survivors of hospitalized AKI was not associated with increased risk of subsequent AKI but was associated with lower risk of death.

Funding

  • NIDDK Support