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Angiotensin II Receptor Blocker Associated With Less Outcome Risk in Patients With Acute Kidney Disease
Vin-Cent Wu1, Yu-Feng Lin1, Nai-Chi Teng2
1Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Insights
Continuing angiotensin receptor blockers (ARBs) after acute kidney injury with dialysis (AKI-D) was linked to lower mortality. However, new users of angiotensin-converting-enzyme inhibitors (ACEis) faced higher re-dialysis risk.
Area of Science:
- Nephrology
- Pharmacology
- Clinical Medicine
Background:
- Acute kidney injury requiring dialysis (AKI-D) is a critical condition with significant patient outcomes.
- Angiotensin-converting-enzyme inhibitors (ACEis) and angiotensin receptor blockers (ARBs) are commonly used medications in kidney disease management.
- The impact of continuing or initiating ACEis/ARBs after AKI-D recovery on long-term prognosis remains incompletely understood.
Purpose of the Study:
- To investigate the association between the use of ACEis or ARBs and patient outcomes after weaning from AKI-D.
- To evaluate the risks of all-cause mortality and re-dialysis (end-stage kidney disease) associated with ACEi/ARB use post-AKI-D.
Main Methods:
- A case-control study involving 41,731 patients weaned from AKI-D for at least 7 days in Taiwan.
- Patients were categorized based on their use of ACEis and ARBs before and after AKI-D.
- Outcomes including all-cause mortality and new-onset end-stage kidney disease (re-dialysis) were assessed over a mean follow-up of 1.01 years.
Main Results:
- Continuing ARB use post-weaning was associated with a significantly lower risk of long-term all-cause mortality compared to non-users.
- New initiation of ACEis during the acute kidney disease (AKD) period was linked to a higher risk of re-dialysis after weaning.
- Neither ACEi nor ARB use was associated with a significantly increased risk of hyperkalemia after weaning from AKI-D.
Conclusions:
- Continuing ARB therapy after AKI-D is associated with reduced all-cause mortality.
- Initiating ACEis in the AKD phase post-AKI-D may increase the risk of subsequent re-dialysis.
- ACEi/ARB use in AKI-D survivors does not appear to elevate hyperkalemia risk, but further prospective studies are warranted.
Abstract:
Objective: The aim of this study was to explore the respective use of angiotensin-converting-enzyme inhibitors (ACEis) or angiotensin receptor blockers (ARBs) on the outcomes of patients who could be weaned from dialysis-requiring acute kidney injury (AKI-D). Methods: This case-control study enrolled 41,731 patients who were weaned from AKI-D for at least 7 days from Taiwan's National Health Insurance Administration. We further grouped AKI-D patients according to ACEi and ARB use to evaluate subsequent risks of all-cause mortality and re-dialysis. The outcomes included the all-cause mortality and new-onset of end-stage kidney disease (ESKD; re-dialysis) following withdraw from AKI-D. Results: A total of 17,141 (41.1%) patients surviving AKI-D could be weaned from dialysis for at least 7 days. The overall events of mortality were 366 (48.9%) in ACEi users, 659 (52.1%) in ARB users, and 6,261 (41.3%) in ACEi/ARB nonusers, during a mean follow-up period of 1.01 years after weaning from AKI-D. In regard to all-cause of mortality, pre-dialysis ARB users had lower incidence than ACEi users [hazard ratio (HR 0.82), p = 0.017]. Compared with ACEi/ARB nonusers, continuing ARB users had a significantly low risk of long-term all-cause mortality (adjusted hazard ratio 0.51, p = 0.013) after propensity score matching. However, new users of ACEi at the acute kidney disease (AKD) period had a higher risk of re-dialysis after weaning than ACEi/ARB nonusers (aHR 1.82, p < 0.001), whereas neither ACEi nor ARB users confronted significantly increased risks of hyperkalemia after weaning. Conclusions: Compared with patients without ACEi/ARB, those continuing to use ARB before the event and after weaning had low all-cause mortality, while new users of ACEi at AKD had increased risk of re-dialysis. AKI-D patients continuing to use ACEi or ARB did not have higher risk of hyperkalemia. Future prospective randomized trials are expected to confirm these findings.
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