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Abstract: TH-OR07

Cardiovascular Drug Use After AKI Among Hospitalized Patients with a History of Myocardial Infarction: A Population-Based Study

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Meraz-Munoz, Alejandro Y., University of Toronto, Toronto, Ontario, Canada
  • Jeyakumar, Nivethika, ICES, London, Ontario, Canada
  • Luo, Bin, ICES, London, Ontario, Canada
  • Beaubien-Souligny, William, Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada
  • Chanchlani, Rahul, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
  • Clark, Edward George, University of Ottawa, Ottawa, Ontario, Canada
  • Harel, Ziv, University of Toronto, Toronto, Ontario, Canada
  • Kitchlu, Abhijat, University of Toronto, Toronto, Ontario, Canada
  • Neyra, Javier A., University of Kentucky Medical Center, Lexington, Kentucky, United States
  • Zappitelli, Michael, University of Toronto, Toronto, Ontario, Canada
  • Chertow, Glenn Matthew, Stanford University, Palo Alto, California, United States
  • Garg, Amit X., London Health Sciences Centre, London, Ontario, Canada
  • Wald, Ron, University of Toronto, Toronto, Ontario, Canada
  • Silver, Samuel A., Queen's University, Kingston, Ontario, Canada
Background

Patients who survive an episode of acute kidney injury (AKI) are at increased risk of cardiovascular morbidity and mortality but may receive fewer cardioprotective drugs than patients without AKI. Our main objective was to evaluate the use of cardiovascular drugs after AKI among hospitalized patients with myocardial infarction (MI).

Methods

We conducted a population-based study of patients aged ≥ 66 years old with a prior history of MI, hospitalized from January 1, 2008, to March 31, 2017. We ascertained AKI using KDIGO serum creatinine criteria. We used propensity score matching to assemble a cohort of patients with and without AKI. The primary outcome was time to receipt of prescriptions for ACEi/ARB, beta-blocker, and statin (all 3 drugs) within one year of hospital discharge. We utilized proportional subdistribution hazards regression, accounting for the competing risk of death, to determine the cumulative incidence of receipt of cardiovascular drugs after AKI compared to patients without AKI.

Results

We identified 28,871 patients with AKI, of whom 21,452 were matched 1:1 to similar patients without AKI. Acute kidney injury was associated with a 7% (95% CI 5-9%) lower likelihood of receiving all 3 cardiovascular drug classes within one year of hospital discharge. This result was largely driven by a 13% (95% CI 11-15%) lower likelihood of ACEi/ARB prescription across all categories of AKI severity. Lower use of beta-blockers and statins was observed in severe AKI. Conversely, AKI was associated with more frequent use of loop diuretics (sHR=1.20, 95% CI 1.17-1.23) and mineralocorticoid receptor antagonists (sHR=1.22, 95% CI 1.15-1.28). The use of most medications stabilized at 3 months post-AKI.

Conclusion

In patients with a history of myocardial infarction, survivors of AKI were less likely to receive prescriptions for all 3 cardiovascular drug classes with strong evidence (ACEi/ARB, beta-blocker, and statin) and more likely to receive loop diuretics and mineralocorticoid receptor antagonists within one year of hospital discharge. Most medication changes stabilized at 3 months, indicating a critical timeframe to provide follow-up care.