Abstract: TH-PO063
Associations of RAASi Discontinuation with Mortality Among Hospitalized Patients with Cardiovascular Disease in Brazil
Session Information
- AKI: Liver Disease, Nephrotoxicity, Novel Therapeutics
November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Tome, Ana Carolina Nakamura, Hospital de Base, Sao Jose do Rio Preto, SP, Brazil
- Lopes, Marcelo, Hospital Sao Rafael, Salvador, Bahia, Brazil
- Ferrés, Paola B. S., Hospital de Base, Sao Jose do Rio Preto, SP, Brazil
- Dos santos, Karise Fernandes, Hospital de Base, Sao Jose do Rio Preto, SP, Brazil
- Santos, Ludmila B S, Hospital Sao Rafael, Salvador, Bahia, Brazil
- Dultra, Isadora Goncalves, Hospital Sao Rafael, Salvador, Bahia, Brazil
- Ramalho, Rodrigo J., Hospital de Base, Sao Jose do Rio Preto, SP, Brazil
- Lima, Emerson Quintino, Hospital de Base, Sao Jose do Rio Preto, SP, Brazil
Background
It is consensus that renin-angiotensin-aldosterone system inhibitors (RAASi) are a pillar of drugs used for cardiovascular and renal protection, however their effects during an AKI episode are still controversial and most guidelines suggest their discontinuation. The aim of the study is to compare the mortality of hospitalized patients with cardiovascular diseases who developed AKI and discontinued the inhibitors with those who maintained their use.
Methods
We analyzed data from a cohort of hospitalized patients in Hospital de Base - São José do Rio Preto with cardiovascular disease (coronary artery disease and heart failure) identified by an AKI alert, in 2018 and 2020, based on the KDIGO creatinine criteria, who were using RAASi. Discontinuation of RAASi was defined as the suspension of their prescription for up to 3 days after the AKI alert. We used a Poisson model to estimate the adjusted risk of death predicted by the RAASi discontinuation. Race, sex and age were used as possible confounders.
Results
Our cohort consisted of 1683 patients, with a mean age of 63 years of age with 56% male. Of the patients there were using RAASi within 24 hours of the AKI alert, 729 remained off the medications 72 hours later. The patients that discontinued RAASi had a greater risk of death (31% vs 19%) when compared to the patients who remained using them. When accounting for possible confounders, the risk of death for the RAASi discontinuation group was 54% higher (RR=1.54 (1.30, 1.83)) than for those that remained using the drugs.
Conclusion
In patients with cardiovascular disease, that developed AKI during the hospital stay, the strategy of RAASi discontinuation may be associated with higher mortality. Although there are limitations, due to the observational nature of this analysis, this data supports that this class of drugs should not be withdrawn routinely in the inpatient setting.