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Hypertension drugs associated with lower mortality in acute kidney injury

Patients with acute kidney injury receiving angiotensin-converting enzyme inhibitor and angiotensin receptor blocker therapy had lower odds of dying but higher odds of being hospitalized for a renal cause, according to data published in JAMA Internal Medicine.

“Patients with acute kidney injury (AKI) are at an increased long-term risk of death,” Sandeep Brar, MD, from the department of nephrology at the University of Toronto, and colleagues wrote. “Effective strategies that improve long-term outcomes in patients with AKI are unknown.”

Brar and colleagues conducted a retrospective cohort study using data from the Alberta Kidney Disease Network population database to determine if there is an association between angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) after hospital discharge and better outcomes in patients with AKI.

Outcomes assessed included mortality, renal-related hospitalization, end-stage renal disease (ESRD) and a composite outcome of ESRD or sustained doubling of serum creatinine concentration. The researchers defined AKI as an increase of 50% between prehospital and peak in-hospital serum creatinine concentrations. A total of 46,253 adults aged 18 years or older (mean age, 68.6 years; 52.8% men) who experienced an episode of AKI during a hospitalization were included.

Nearly half (48%) of participants were using an ACEI or ARB within 6 months of being discharged from the hospital.

In the adjusted analysis, participants using ACEIs and ARBs had a lower risk for mortality after 2 years (adjusted HR = 0.85; 95% CI, 0.81-0.89), but a higher risk of hospitalization for a renal cause (aHR = 1.28; 95% CI, 1.12-1.46). ACEI or ARB use was not associated with progression to ESRD.

These findings require “further evaluation in prospective studies evaluating post-discharge care strategies for patients with AKI,” Brar and colleagues concluded. “In particular, our results suggest a need for a trial to evaluate treatment with an ACEI or ARB in patients with AKI to determine whether this intervention improves long-term outcomes in high-risk patients.” – by Alaina Tedesco

Disclosure: The authors report no relevant financial disclosures.