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Impact of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers on Renal Function in Type 1
Daniel T Ilges1, Morgan L Dermody2, Caitlyn Blankenship2
1Department of Pharmacy Services, 25213SSM Health Saint Louis University Hospital, St. Louis, MO, USA.
Insights
Discontinuing angiotensin-converting enzyme inhibitors (ACE-I) or angiotensin receptor blockers (ARBs) in acute heart failure with acute kidney injury (AKI) did not improve renal function. This study found no significant difference in serum creatinine changes between patients who stopped or continued ACE-I/ARBs.
Area of Science:
- Cardiology
- Nephrology
- Pharmacology
Background:
- Discontinuation of ACE-I/ARBs in acute heart failure (AHF) is linked to higher mortality.
- Acute kidney injury (AKI) in cardiorenal syndrome (CRS) is associated with renal venous congestion.
- ACE-I/ARB withdrawal (AW) may theoretically aid renal recovery, but its impact in CRS is understudied.
Purpose of the Study:
- To compare the effects of ACE-I/ARB withdrawal (AW) versus continuation (AC) on renal function in patients with type 1 CRS.
- To investigate the impact of AW on serum creatinine levels within 72 hours of admission for AHF and AKI.
Main Methods:
- Retrospective, single-center chart review of 111 patients aged 18-89 with AHF and AKI.
- Patients were treated with ACE-I/ARB prior to admission.
- Primary endpoint: change in serum creatinine (SCr) from admission to 72 hours; analyzed using chi-square and Mann-Whitney U tests.
Main Results:
- No significant difference in median SCr change between AW (-0.1 mg/dL) and AC (0.0 mg/dL) groups at 72 hours (P=0.05).
- No difference in SCr reduction ≥0.3 mg/dL, 30-day readmissions, or discharge ACE-I/ARB prescription between groups.
- AW patients had higher admission BUN, SCr, and lower ejection fraction.
Conclusions:
- ACE-I/ARB withdrawal in type 1 CRS is not associated with improved renal function at 72 hours.
- Larger sample sizes are needed to confirm these findings.
- Further research is warranted to optimize medication management in CRS.
Introduction:
Angiotensin-converting enzyme inhibitor (ACE-I) and angiotensin receptor blocker (ARB) discontinuation during acute heart failure (AHF) is associated with increased mortality following hospitalization. Although the etiology of acute kidney injury (AKI) in type 1 cardiorenal syndrome (CRS) has been linked to renal venous congestion, ACE-I/ARB withdrawal (AW) theoretically promotes renal function recovery. ACE-I/ARBs are dose-reduced or withheld in approximately half of patients with CRS, but the subsequent impact on renal function remains largely uninvestigated. This study compared AW to ACE-I/ARB continuation (AC) during CRS.
Methods:
This was a retrospective, single-center chart review. Patients aged 18-89 years admitted from April 2018 to August 2019 with AHF and AKI were identified using discharge ICD-10 codes. All patients were treated with an ACE-I/ARB before admission. Key exclusion criteria included shock, pregnancy, and end-stage renal disease. The primary endpoint was change in serum creatinine (SCr) from admission through 72 hours. Data were analyzed utilizing chi-square and Mann-Whitney U tests with SPSS software.
Results:
A total of 111 admissions were included. AW occurred in 68 patients upon admission. AW patients presented with a higher blood urea nitrogen (P = 0.034), higher SCr (P = 0.021), and lower ejection fraction (P = 0.04). Median SCr change from admission to 72 hours did not differ between groups (AW -0.1 mg/dL vs AC 0.0 mg/dL, P = 0.05). There was no difference in SCr reduction ≥0.3 mg/dL at 72 hours, 30-day readmissions, or ACE-I/ARB prescription at discharge.
Conclusions:
In patients with type 1 CRS, AW was not associated with improved renal function at 72 hours. A larger sample size is necessary to confirm these results.
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01:30Antihypertensive Drugs: Angiotensin-Converting Enzyme Inhibitors
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01:22Heart Failure Drugs: Diuretics