Commonly prescribed medication shows no link to recurrent AKI, may decrease mortality risk
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Study findings indicated use of renin-angiotensin aldosterone inhibitors after AKI did not increase risk for recurrent episodes 1 year after hospital discharge.
In addition, patients who discontinued use appeared to have an increased mortality risk.
Researchers did, however, observe a “modest increase” in recurrent AKI risk among patients with chronic kidney disease with RAASi use, leading them to recommend prescription practices be “balanced with individual overall risk for recurrent AKI and with adequate monitoring.”
According to Edward D. Siew, MD MSCI, of Tennessee Valley Health System, Veteran’s Health Administration and Vanderbilt University Medical Center, and colleagues, blockade of the renin-angiotensin-aldosterone syndrome (RAASi) with angiotensin converting enzyme inhibition or angiotensin receptor blockers has been shown to benefit patients with a variety of conditions prevalent in those who experience AKI, including diabetes, cardiovascular disease and proteinuric CKD.
“However, some studies suggest that the benefit of RAASi may be limited in certain populations, such as the elderly, or even deleterious when applied in excess, such as with dual RAASi use,” they wrote. “Given these observations, concerns have been raised as to whether continued RAASi use in the setting of recent AKI may lower the threshold for future injury.”
To further investigate the association of RAASi use at hospital discharge with an episode of recurrent AKI or mortality, Siew and colleagues conducted a retrospective cohort study of 96,983 veterans who survived stage 2 or 3 AKI.
Among the total study population, 40% were on RAASi at discharge.
While the researchers found no difference in risk for recurrent AKI between patients who continued or discontinued RAASi use at 12 months, they observed that discontinuing use was associated with a significantly higher risk for mortality (hazard ratio = 1.33).
Additional findings suggested no differences in recurrent AKI risk between non-users compared with prevalent users who continued RAASi.
Similar results were seen in subgroup analyses of patients with diabetes, heart failure and malignancy, though the researchers noted that discontinuation of therapy appeared to modestly reduce the risk in patients with CKD.
“Patients with CKD were observed to have a modest increase in risk of recurrent AKI with RAASi use; however, use also remained associated with a modest improvement in survival,” the researchers elaborated.
According to Siew and colleagues, while the findings are promising, caution should be used in “overinterpreting” the results and clinicians should not conclude that resuming or initiating the therapy in all patients with AKI is safe and effective.
“Despite having moderate to severe AKI, most patients in our cohort had recovered a significant amount of kidney function by the time of discharge and mean potassium levels were in the normal range,” they wrote, adding it is necessary to tailor treatment based on individual patient’s risk and that monitoring through follow-up must be prioritized.
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