Abstract: FR-OR007
Discontinuation of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers During AKI Varies Substantially by Treatment Facility
Session Information
- AKI Everywhere All at Once: Risks, Trajectories, and Practice Patterns
November 07, 2025 | Location: Room 320A, Convention Center
Abstract Time: 05:30 PM - 05:40 PM
Category: Acute Kidney Injury
- 101 AKI: Epidemiology, Risk Factors, and Prevention
Authors
- Griffin, Benjamin R., Iowa City VA Medical Center, Iowa City, Iowa, United States
- Yamada, Masaaki, Iowa City VA Medical Center, Iowa City, Iowa, United States
- Swee, Melissa L., Iowa City VA Medical Center, Iowa City, Iowa, United States
- Jalal, Diana I., Iowa City VA Medical Center, Iowa City, Iowa, United States
- Sarrazin, Mary Vaughan, Iowa City VA Medical Center, Iowa City, Iowa, United States
Background
Angiotensin converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) have been shown to decrease progression of chronic kidney disease, prevent cardiovascular events, and improve long-term mortality in appropriate patient populations. However, these agents are frequently discontinued in the setting of in-hospital acute kidney injury (AKI) and often not restarted after discharge. In this analysis we evaluated patient factors and facility variation associated with in-hospital discontinuation of ACEI/ARBs following AKI across 139 Veterans Affairs (VA) hospitals.
Methods
Veterans previously on an ACEI/ARB admitted to a VA hospital between 2014 and 2023 who experienced AKI, defined as a creatinine increase of ≥0.3 mg/dL at or after admission, were included. Multi-level multivariable regression models for ACEI/ARB discontinuation after AKI were created with 30 variables including demographics, comorbidities, AKI severity, year of admission, and VA facility random effects.
Results
We identified 323,319 Veterans on ACEI/ARB who developed AKI during a VA hospitalization, and 157,513 (49%) received at least one in-hospital dose of ACEI/ARB after AKI development. After excluding in-hospital deaths, only 85,254 (55%) who discontinued in-hospital ACE/ARB after AKI restarted these medications within 6 months of discharge, compared to 128,166 (83%) among patients who continued to receive an ACEI/ARB during the hospital episode. There were substantial variations in ACEI/ARB discontinuation across facilities, with an adjusted median odds ratio (a comparison of two randomly selected facilities) of 1.40 (95% CI 1.34-1.46). In addition, odds of discontinuation were higher for patients experiencing AKI in later years of the data (aOR 1.13, 95% CI 1.10-1.17, comparing 2023 to 2014).
Conclusion
Veterans who discontinue in-hospital ACEI/ARB after AKI are significantly less likely to receive these medications after discharge. Odds of in-hospital ACEI/ARB discontinuation are increasing over time, and variation across VA facilities was substantial. Future research should explore factors accounting for these facility-level differences and should implement systems to minimize unnecessary ACEI/ARB discontinuation.
Funding
- Veterans Affairs Support