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Effects of Renin-Angiotensin-Aldosterone System Inhibitor Discontinuation After Acute Kidney Injury on Mortality: A
Daniel Feldman1, Bryce Grohol1, Vincent Mack1
1Department of Medicine, Christiana Care Health System, Newark, Delaware.
Insights
Discontinuing renin-angiotensin-aldosterone inhibitors (RAASi) for patients with heart failure and acute kidney injury significantly increases 1-year mortality. Continuing RAASi treatment is crucial for better outcomes in this high-risk group.
Area of Science:
- Cardiology
- Nephrology
- Pharmacology
Background:
- Guideline-directed medical therapy, including renin-angiotensin-aldosterone inhibitors (RAASi), reduces heart failure mortality.
- RAASi are frequently discontinued during acute kidney injury (AKI) admissions and often not restarted.
- The impact of RAASi discontinuation on mortality after AKI in heart failure patients is not well understood.
Purpose of the Study:
- To investigate the association between RAASi discontinuation and 1-year mortality in heart failure patients following an acute kidney injury.
- To evaluate the impact of restarting or continuing RAASi therapy after AKI on patient survival.
Main Methods:
- Retrospective, propensity-matched analysis of 512 heart failure patients admitted with AKI between 2016 and 2021.
- Data extracted from electronic health records of a US tertiary care health system.
- Exposure: RAASi discontinuation versus continuation at discharge; Outcome: 1-year mortality.
Main Results:
- RAASi discontinuation at discharge was associated with a 1.96-fold increased risk of 1-year mortality (OR 1.96, 95% CI 1.28-2.99, p <0.001).
- Patients continued on RAASi demonstrated significantly better survival rates at 1 year post-discharge.
Conclusions:
- Discontinuation of RAASi after AKI in heart failure patients is linked to substantially higher mortality.
- Optimizing RAASi treatment regimens is critical for improving outcomes in this vulnerable patient population.
Abstract:
Guideline directed medical therapy to include renin-angiotensin-aldosterone inhibitors (RAASi) has led to a significant reduction in heart failure mortality. These medications, however, are often discontinued on admission for an acute kidney injury and never restarted. The impact of this discontinuation on mortality is unknown. This retrospective, propensity matched, analysis between 2016 and 2021 sought to examine the impact that discontinuation of RAASi, after an acute kidney injury, has on 1 year mortality in patients with heart failure. Data were obtained using the electronic health record of a tertiary care health system in the United States. The exposure was whether the patient's RAASi was discontinued on discharge and the outcome was 1 year mortality. We found that, among patients admitted for an acute kidney injury with heart failure who were on an RAASi at the time of admission (n = 512), discontinuation of the patient's RAASi on discharge was associated with 1.96 times as many deaths at 1 year (OR 1.96, 95% CI 1.28 to 2.99, p <0.001) compared to those who were continued on their RAASi. These findings emphasize the potential impact on patient outcomes and the importance of optimizing treatment regimens in this high-risk population.
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