Brar S, et al. - Using data from the Alberta Kidney Disease Network population database, researchers conducted this retrospective cohort study to determine if the use of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) after hospital discharge is related to better outcomes in patients with acute kidney injury (AKI). Findings suggested that ACEI or ARB therapy seemed to be related to lower mortality but a higher risk of hospitalization for a renal cause among patients with AKI. A potential benefit of ACEI or ARB use after AKI was suggested; however, careful monitoring for renal-specific complications may be warranted.

Methods

• Researchers assessed 46,253 adults aged 18 years or older with an episode of AKI during a hospitalization between July 1, 2008, and March 31, 2015, in Alberta, Canada.
• For this investigation, all patients who survived to hospital discharge were followed up for a minimum of 2 years.
• Main exposure analyzed was use of an ACEI or ARB within 6 months after hospital discharge.
• Mortality was the primary outcome.
• Hospitalization for a renal cause, end-stage renal disease (ESRD), and a composite outcome of ESRD or sustained doubling of serum creatinine concentration were included secondary outcomes.
• They characterized AKI as a 50% increase between prehospital and peak in-hospital serum creatinine concentrations.
• Using propensity scores, researchers constructed a matched-pairs cohort of patients who did and did not have a prescription for an ACEI or ARB within 6 months after hospital discharge.

Results

• The investigators assessed 46,253 adults (mean [SD] age, 68.6 [16.4] years; 24,436 [52.8%] male).
• A total of 22,193 (48.0%) participants were prescribed an ACEI or ARB within 6 months of discharge.
• After adjustment for comorbidities, ACEI or ARB use before admission, demographics, baseline kidney function, other factors related to index hospitalization, and prior health-care services, ACEI or ARB use was correlated with lower mortality in patients with AKI after 2 years (adjusted hazard ratio, 0.85; 95% CI, 0.81-0.89).
• Data reported that patients who received an ACEI or ARB had a higher risk of hospitalization for a renal cause (adjusted hazard ratio, 1.28; 95% CI, 1.12-1.46).
• They did not find association between ACEI or ARB use and progression to ESRD.