Abstract: PO0193
Associations of RAS Inhibitor Suspension During AKI with Mortality in Hospitalized Patients
Session Information
- AKI: Epidemiology, Risk Factors, and Prevention
November 04, 2021 | Location: On-Demand, Virtual Only
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 101 AKI: Epidemiology, Risk Factors, and Prevention
Authors
- Tome, Ana carolina Nakamura, Hospital de Base, Sao Jose do Rio Preto, SP, Brazil
- Lopes, Marcelo, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
- Santos Menezes Lopes, Daniela, Universidade Federal da Bahia, Salvador, BA, Brazil
- Ramalho, Rodrigo J., Hospital de Base, Sao Jose do Rio Preto, SP, Brazil
- Lima, Emerson Quintino, Faculdade de Medicina de Sao Jose do Rio Preto, Sao Jose do Rio Preto, SP, Brazil
Background
Blockade of the renin-angiotensin system may slow disease progression and prevent mortality in patients with chronic kidney disease. However, it is unclear whether RASi can increase the risk of developing AKI and its complications in hospitalized patients. The aim of the study is to compare mortality of patients with AKI who have discontinued RASi to those who maintained its use.
Methods
We analyzed data from a cohort of hospitalized patients identified by an AKI alert based on KDIGO creatinine criteria, who were on a RASi. From January to December, 2018, suspension of RASi medications was defined by the lack of its prescription until 3 days after AKI alert in their electronic health records. Cox models were used to test the association of RASi suspension with all-cause mortality, adjusting for possible confounders: age, sex, race, baseline and worst achieved GFRs, potassium, hemoglobin levels and episodes of hypotension during the hospitalization.
Results
During hospitalization 1253 patients were on a RASi. After the AKI alert, 493 remained and 760 suspended its use. The median [IQR] follow-up time was 11.9 [7.20-20.8] days. Patient characteristics were similar across treatment strategies. In the suspended group more patients needed dialysis (13% vs 4%) and were admitted to intensive care units (66% vs 55%); mean potassium levels were consistent across groups (4.45 mg/dL (0.72) vs 4.39 mg/dL (0.67) for the patients who remained on RASi). There was a strong association of RASi suspension with death as shown in the figure.
Conclusion
Among patients with AKI, the strategy of suspending RASi resulted in a twofold higher death rate than for those who remained on the medication, even after adjustment for possible confounders. These findings suggest that an individualized approach to RASi therapy may be warranted in the hospitalized patient with AKI.