Feidakis Athanasios, Panagiotou Maria-Rosa, Tsoukakis Emmanouil, Bacharaki Dimitra, Gounari Paraskevi, Nikolopoulos Petros, Marathias Katerina P, Lionaki Sophia, Vlahakos Demetrios
2nd Department of Internal Medicine, National and Kapodistrian University of Athens Medical School, Attikon University Hospital, 1 Rimini Street, Haidari, 11527 Athens, Greece.
Intensive Care Unit, Onassis Cardiac Surgery Center, 17674 Athens, Greece.
J Clin Med. 2021 Jan 22;10(3):412. doi: 10.3390/jcm10030412.
Acute kidney injury (AKI) has been observed in up to 20% of adult hospital admissions. Sepsis, diarrhea and heart failure, all causing reduced effective volume, are considered risk factors for AKI, especially among patients treated with medications that block the Renin-Angiotensin System (RAS), such as angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB). We aimed to determine the incidence of acute kidney injury (AKI) in emergency medical admissions in relation to the use and dosage of ACEi/ARB.
A single-center observational study conducted in 577 consecutive medical admissions via the Emergency Room (ER) at a University General Hospital in Athens, Greece, between June and July 2018. Patients with incomplete medical records, discharged within 24 h, maintained on chronic renal replacement therapy, admitted to the Cardiology Department or the ICU were excluded. Thus, a total of 309 patients were finally included in this analysis.
We compared 86 (28%) patients who presented in the ER with AKI (AKIGroup) with 223 (72%) patients without AKI (non-AKI Group) at the time of admission. Patients in the AKI Group were more frequently male (58% vs. 46%, = 0.06), with a higher frequency of diarrhea (16% vs. 6%, = 0.006), edema (15% vs. 6%, = 0.014) and lower systolic blood pressure (120 (107-135) vs. 126 (113-140), = 0.007) at presentation, despite higher prevalence of hypertension (64% vs. 47%, = 0.006). Overall, ACEi/ARB were more likely to have been prescribed in the AKI Group than in the non-AKI Group (49% vs. 28%, = 0.001). Interestingly, AKI was more frequently observed in patients treated with the target or above target dosage of ACEi/ARB, but not in those receiving lower than the recommended dosage.
The risk of AKI in emergency medical admissions is higher among users of ACEIs/ARB at target or above target dosages. Physicians should adjust RAS blockade according to estimated Glomerular Filtration Rate (eGFR) and advise their patients to withhold ACEi/ARB in cases of acute illness.
在高达20%的成年住院患者中观察到急性肾损伤（AKI）。脓毒症、腹泻和心力衰竭，均会导致有效血容量减少，被认为是AKI的危险因素，尤其是在接受阻断肾素 - 血管紧张素系统（RAS）药物治疗的患者中，如血管紧张素转换酶抑制剂（ACEi）和血管紧张素受体阻滞剂（ARB）。我们旨在确定急诊入院患者中急性肾损伤（AKI）的发生率与ACEi/ARB的使用及剂量之间的关系。
2018年6月至7月间，在希腊雅典一家大学综合医院通过急诊室（ER）对577例连续入院的内科患者进行了一项单中心观察性研究。排除病历不完整、在24小时内出院、维持慢性肾脏替代治疗、入住心内科或重症监护病房（ICU）的患者。因此，本分析最终共纳入309例患者。
我们将86例（28%）在急诊时出现AKI的患者（AKI组）与223例（72%）入院时未出现AKI的患者（非AKI组）进行了比较。AKI组患者男性比例更高（58%对46%，P = 0.06），腹泻发生率更高（16%对6%，P = 0.006），水肿发生率更高（15%对6%，P = 0.014），就诊时收缩压更低（120（107 - 135）对126（113 - 140），P = 0.007），尽管高血压患病率更高（64%对47%，P = 0.006）。总体而言，AKI组比非AKI组更有可能使用ACEi/ARB（49%对28%，P = 0.001）。有趣的是，在接受目标剂量或高于目标剂量ACEi/ARB治疗的患者中更常观察到AKI，但在接受低于推荐剂量治疗的患者中未观察到。
在急诊入院患者中，使用目标剂量或高于目标剂量ACEIs/ARB的患者发生AKI的风险更高。医生应根据估计的肾小球滤过率（eGFR）调整RAS阻断，并建议患者在急性疾病情况下停用ACEi/ARB。
