Pre-operative maintenance of angiotensin-converting enzyme inhibitors is not associated with acute kidney injury in...

Area of Science:

• Cardiology
• Nephrology
• Anesthesiology

Background:

• Angiotensin-converting enzyme inhibitors (ACE inhibitors) are commonly prescribed for cardiovascular conditions.
• The perioperative management of ACE inhibitors in patients undergoing cardiac surgery remains a topic of debate.
• Concerns exist regarding potential adverse effects of continuing ACE inhibitors on the day of surgery, particularly acute kidney injury (AKI) and cardiac complications.

Purpose of the Study:

• To investigate the association between the maintenance of ACE inhibitors on the day of cardiac surgery and the incidence of postoperative AKI.
• To evaluate the impact of ACE inhibitor maintenance on major postoperative cardiac events in patients undergoing cardiac surgery.

Main Methods:

• A multicentric observational study involving 1,072 patients treated with ACE inhibitors.
• Propensity score matching was employed to control for confounding variables.
• Data collected included baseline demographics, comorbidities, and operative and postoperative outcomes.
• AKI was defined according to KDIGO criteria.

Main Results:

• Maintenance of ACE inhibitors on the day of surgery was not associated with an increased risk of postoperative AKI (OR: 1.215; p = 0.843).
• Multivariate logistic regression and sensitivity analyses confirmed no association between ACE inhibitor maintenance and AKI (OR: 1.03).
• No statistically significant differences were observed in the incidence of cardiogenic shock, stroke, vasoplegia, postoperative atrial fibrillation, or mortality.
• Intensive care unit and hospital lengths of stay did not differ between groups.

Conclusions:

• Continuing ACE inhibitors on the day of cardiac surgery is not associated with an increased risk of postoperative AKI.
• Maintenance of ACE inhibitors does not lead to a higher rate of major postoperative cardiovascular events.
• These findings suggest that current practices of maintaining ACE inhibitors perioperatively in cardiac surgery patients are safe regarding AKI and cardiac complications.