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Abstract: FR-PO019

Preoperative Medication Use and Development of Postoperative AKI

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Long, Thorir E., University of Iceland, Reykjavik, Iceland
  • Helgason, Dadi, University of Iceland, Reykjavik, Iceland
  • Palsson, Runolfur, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
  • Sigurdsson, Martin I., Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
  • Indridason, Olafur S., Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
Background

The use of medications such as angiotensin-converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARB) and proton pump inhibitors (PPI) has been associated with acute kidney injury (AKI), whereas animal data suggest that aldosterone antagonists (AA) may be protective. The aim of this study was to examine the relationship between the preoperative use of these medications and development of postoperative AKI.

Methods

This was a retrospective study of adult patients (excluding those with CKD stage 5) who underwent abdominal, cardiothoracic, vascular or orthopedic surgery at the University Hospital in Reykjavik in 2006-2015. Clinical data and disease diagnoses was retrieved from electronic medical records. AKI was defined based on serum creatinine (SCr) according the the KDIGO criteria. Information on medication use was obtained from the National Prescription Drug Database of the Directorate of Health and patients were considered to be using a medication if they had filled a prescription within six months prior to surgery. A daily defined dose (DDD) was determined for all patients. Risk of AKI was assessed using multivariable logistic regression analysis.

Results

A total of 42,047 abdominal, cardiothoracic, vascular or orthopedic surgeries were performed on 28,418 patients during the study period. Pre- and postoperative SCr was available for 19,279 cases. Postoperative AKI occurred in 1,455 (7.5%) cases. A total of 6,568 (34%) patients filled a prescription for a PPI prior to surgery, 547 (8.3%), of whom developed AKI. Of 6,717 (35%) patients who received ACEi, ARB or AA before surgery, 724 (10.8%) developed AKI. In adjusted analysis, the odds ratio (95% CI) for AKI was 1.00 (0.89-1.13) for PPI, 1.07 (0.93-1.23) for ACEi, 1.30 (1.15-1.48) for ARB and 0.83 (0.62-1.09) for AA. When DDD were examined, there was no evidence of a dose-response relationship between medication use and postoperative AKI.

Conclusion

In this surgical cohort, we found that preoperative use of ARB associated with postoperative AKI. However, no such a risk was evident for PPI and a protective effect of AA was not observed.

Funding

  • Government Support - Non-U.S.