Department of Epidemiology and Biostatistics, University of California, San Francisco, California.
Departments of Medicine and Anesthesia, University of California, San Francisco, California.
Clin J Am Soc Nephrol. 2020 Dec 31;16(1):26-36. doi: 10.2215/CJN.10840720. Epub 2020 Dec 3.
The risk-benefit ratio of angiotensin-converting enzyme inhibitor or angiotensin receptor blocker therapy after AKI may be altered due to concerns regarding recurrent AKI. We evaluated, in a prospective cohort, the association between use (versus nonuse) of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and the subsequent risk of AKI and other adverse outcomes after hospitalizations with and without AKI.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We studied 1538 patients recently discharged from the hospital who enrolled in the multicenter, prospective ASSESS-AKI study, with approximately half of patients experiencing AKI during the index hospitalization. All participants were seen at a baseline visit 3 months after their index hospitalization and were categorized at that time on whether they were using angiotensin-converting enzyme inhibitors/angiotensin receptor blockers or not. We used multivariable Cox regression, adjusting for demographics, comorbidities, eGFR, urine protein-creatinine ratio, and use of other medications, to examine the association between angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use and subsequent risks of AKI, death, kidney disease progression, and adjudicated heart-failure events.
The use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers was 50% (386/769) among those with AKI during the index hospitalization and 47% (362/769) among those without. Among those with AKI during the index hospitalization, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use was not associated with a higher risk of recurrent hospitalized AKI (adjusted hazard ratio, 0.88; 95% confidence interval, 0.69 to 1.13). Associations between angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use and death, kidney disease progression, and adjudicated heart-failure events appeared similar in study participants who did and did not experience AKI during the index hospitalization (all interaction values >0.05).
The risk-benefit ratio of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker therapy after hospital discharge appears to be similar regardless of whether AKI occurred during the hospitalization.
血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂治疗急性肾损伤（AKI）后的风险效益比可能会因对复发性 AKI 的担忧而改变。我们在一项前瞻性队列研究中评估了血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂的使用（与不使用相比）与 AKI 后和无 AKI 住院后 AKI 和其他不良结局的风险之间的关系。
设计、地点、参与者和测量：我们研究了最近出院的 1538 名患者，他们参加了多中心前瞻性 ASSESS-AKI 研究，约一半的患者在指数住院期间发生 AKI。所有参与者在指数住院后 3 个月进行基线就诊，并根据他们是否使用血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂进行分类。我们使用多变量 Cox 回归，调整人口统计学、合并症、eGFR、尿蛋白-肌酐比和其他药物的使用，以检查血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂使用与随后 AKI、死亡、肾脏疾病进展和判定心力衰竭事件的风险之间的关系。
在指数住院期间发生 AKI 的患者中，血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂的使用率为 50%（386/769），而在无 AKI 的患者中为 47%（362/769）。在指数住院期间发生 AKI 的患者中，血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂的使用与复发性住院 AKI 的风险增加无关（调整后的危险比，0.88；95%置信区间，0.69 至 1.13）。在指数住院期间发生 AKI 和未发生 AKI 的研究参与者中，血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂的使用与死亡、肾脏疾病进展和判定心力衰竭事件之间的关联似乎相似（所有交互值>0.05）。
血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂治疗出院后 AKI 的风险效益比似乎相似，无论住院期间是否发生 AKI。
