Association between angiotensin converting enzyme inhibitor or angiotensin receptor blocker use prior to major elective surgery and the risk of acute dialysis

Shah, Mitesh; Jain, Arsh K.; Brunelli, Steven M.; Coca, Steven G.; Devereaux, P. J.; James, Matthew T.; Luo, Jin; Molnar, Amber O.; Mrkobrada, Marko; Pannu, Neesh; Parikh, Chirag R.; Paterson, Michael; Shariff, Salimah Z.; Wald, Ron; Walsh, Michael; Whitlock, Richard; Wijeysundera, Duminda N.; Garg, Amit X.

doi:10.1186/1471-2369-15-53

Cited by 40 publications

(22 citation statements)

References 52 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Second, the RAS blockers were not stopped because AKI was often not recognized. The practice of suspending RAS blockers during mild AKI is still debated . Inhibiting angiotensin II using RAS blockers raises the risk of prerenal AKI but may reduce the risk of renal AKI.…”

Section: Discussionmentioning

confidence: 99%

“…Inhibiting angiotensin II using RAS blockers raises the risk of prerenal AKI but may reduce the risk of renal AKI. Indeed, they may decrease tubular cell necrosis during ischemic insults such as dehydration or sepsis by increasing renal blood flow and oxygenation through the vasodilation of efferent arterioles . Nevertheless, CKD is accompanied by failure of vascular autoregulation, which probably does not permit an increase of renal blood flow because of RAS blockers .…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Acute Kidney Injury in Elderly Patients With Chronic Kidney Disease: Do Angiotensin‐Converting Enzyme Inhibitors Carry a Risk?

Chaumont

Pourcelet

Nuffelen

et al. 2016

J of Clinical Hypertension

View full text Add to dashboard Cite

In contrast to angiotensin receptor blockers (ARBs), mainly excreted by the liver, the dosage of angiotensin-converting enzyme (ACE) inhibitors, cleared by the kidney, must be adapted to account for renal clearance in patients with chronic kidney disease (CKD) to avoid acute kidney injury (AKI). Community-acquired AKI and the use of ACE inhibitors or ARBs in the emergency department were retrospectively assessed in 324 patients with baseline stage 3 or higher CKD. After stepwise regression analysis, the use of ACE inhibitors (odds ratio [OR], 1.9; 95% confidence interval [CI], 1.1-3.1; P=.02) and the presence of dehydration (OR, 30.8; 95% CI, 3.9-239.1) were associated with AKI. A total of 45% of patients using ACE inhibitors experienced overdosing, which causes most of the excess risk of AKI. These results suggest that dosage adjustment of ACE inhibitors to renal function or substitution of ACE inhibitors with ARBs could reduce the incidence of AKI. Moreover, ACE inhibitors and ARBs should be stopped in cases of dehydration.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Acute Kidney Injury in Elderly Patients With Chronic Kidney Disease: Do Angiotensin‐Converting Enzyme Inhibitors Carry a Risk?

Chaumont

Pourcelet

Nuffelen

et al. 2016

J of Clinical Hypertension

View full text Add to dashboard Cite

show abstract

“…10 Also, in this regard, we have shown that the propensity for experiencing increase in serum creatinine postcardiac surgery was increased when RAAS antagonists were administered perioperatively; however, there was not a commensurate increase in the kidney injury as measured by several urinary biomarkers. 34,35 In contrast, although no agent has been FDA approved to prevent or ameliorate AKI, there are at least seven trials published over the past 10 years included in this review that Figure 2. Pooled risk ratios for categorical end points of (A) AKI, (B) CKD, and (C) mortality between intervention and control groups in trials that increased the risk for AKI.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Short-Term Changes in Serum Creatinine Level as a Meaningful End Point in Randomized Clinical Trials

Coca¹,

Zabetian

Ferket

et al. 2015

JASN

View full text Add to dashboard Cite

Observational studies have shown that acute change in kidney function (specifically, AKI) is a strong risk factor for poor outcomes. Thus, the outcome of acute change in serum creatinine level, regardless of underlying biology or etiology, is frequently used in clinical trials as both efficacy and safety end points. We performed a meta-analysis of clinical trials to quantify the relationship between positive or negative shortterm effects of interventions on change in serum creatinine level and more meaningful clinical outcomes. After a thorough literature search, we included 14 randomized trials of interventions that altered risk for an acute increase in serum creatinine level and had reported between-group differences in CKD and/or mortality rate $3 months after randomization. Seven trials assessed interventions that, compared with placebo, increased risk of acute elevation in serum creatinine level (pooled relative risk, 1.52; 95% confidence interval, 1.22 to 1.89), and seven trials assessed interventions that, compared with placebo, reduced risk of acute elevation in serum creatinine level (pooled relative risk, 0.57; 95% confidence interval, 0.44 to 0.74). However, pooled risks for CKD and mortality associated with interventions did not differ from those with placebo in either group. In conclusion, several interventions that affect risk of acute, mild to moderate, often temporary elevation in serum creatinine level in placebo-controlled randomized trials showed no appreciable effect on CKD or mortality months later, raising questions about the value of using small to moderate changes in serum creatinine level as end points in clinical trials.

show abstract

“…The median number of pregnancies per mother during the study period was 1 (interquartile range [IQR] 1-2; range 1-11). The median maternal age at delivery was 30 years (IQR [26][27][28][29][30][31][32][33][34]. The prevalence of at least one recorded preexisting medical condition, including hypertension, diabetes mellitus, or chronic kidney disease, was 5.3%.…”

Section: Pregnancies In Ontario Canadamentioning

confidence: 99%

“…25 Maternal cause of death was determined from the Ontario Registrar General Death database, which contains information on all deaths registered in Ontario. 26 We have used these databases in previous studies to research health outcomes and health services including those related to AKI-D. [29][30][31][32] All variables used in this study were complete, with minor exceptions detailed in Supplemental Table 3.…”

Section: Data Sourcesmentioning

confidence: 99%

Characteristics and Outcomes of AKI Treated with Dialysis during Pregnancy and the Postpartum Period

Hildebrand

Liu

Shariff

et al. 2015

Journal of the American Society of Nephrology

View full text Add to dashboard Cite

Acute kidney injury (AKI) is a rare complication of pregnancy, but may be associated with significant morbidity and mortality in young and often otherwise healthy women. We conducted a retrospective population-based cohort study of all consecutive pregnancies over a 15-year period (1997-2011) in Ontario, Canada, and describe the incidence and outcomes of AKI treated with dialysis during pregnancy or within 12 weeks of delivery. Of 1,918,789 pregnancies, 188 were complicated by AKI treated with dialysis (incidence: 1 per 10,000 [95% confidence interval, 0.8 to 1.1]). Only 21 of 188 (11.2%) women had record of a preexisting medical condition; however, 130 (69.2%) women experienced a major pregnancy-related complication, including preeclampsia, thrombotic microangiopathy, heart failure, sepsis, or postpartum hemorrhage. Eight women died (4.3% versus 0.01% in the general population), and seven (3.9%) women remained dialysis dependent 4 months after delivery. Low birth weight (,2500 g), small for gestational age, or preterm birth (,37 weeks' gestation) were more common in pregnancies in which dialysis was initiated (35.6% versus 14.0%; relative risk, 3.40; 95% confidence interval, 2.52 to 4.58). There were no stillbirths and fewer than five neonatal deaths (,2.7%) in affected pregnancies compared with 0.1% and 0.8%, respectively, in the general population. In conclusion, AKI treated with dialysis during pregnancy is rare and typically occurs in healthy women who acquire a major pregnancy-related medical condition such as preeclampsia. Many affected women and their babies have good short-term outcomes. 26: 3085-3091, 201526: 3085-3091, . doi: 10.1681 Pregnancy-related AKI is associated with significant morbidity and mortality inyoung and often otherwise healthy women. 1,2 Since the 1960s, the incidence of pregnancy-related AKI in developed countries has declined from 1 in 3000 to 1 in 18,000. 1 This trend has been closely linked to improved obstetrical care and dramatic reductions in first-trimester AKI attributable to septic abortions. 2 However, these trends are less relevant in contemporary populations. The changing risk profile of pregnant North American women includes lower parity, older age, higher body mass index, and greater comorbidities such as hypertension, diabetes mellitus, and chronic kidney disease, as well as increased use of reproductive technologies resulting in multiple gestations. These changes may have a unique impact on the incidence, etiology, and outcomes of pregnancy-related AKI. [3][4][5][6][7] J Am Soc Nephrol

show abstract

Association between angiotensin converting enzyme inhibitor or angiotensin receptor blocker use prior to major elective surgery and the risk of acute dialysis

Cited by 40 publications

References 52 publications

Acute Kidney Injury in Elderly Patients With Chronic Kidney Disease: Do Angiotensin‐Converting Enzyme Inhibitors Carry a Risk?

Acute Kidney Injury in Elderly Patients With Chronic Kidney Disease: Do Angiotensin‐Converting Enzyme Inhibitors Carry a Risk?

Evaluation of Short-Term Changes in Serum Creatinine Level as a Meaningful End Point in Randomized Clinical Trials

Characteristics and Outcomes of AKI Treated with Dialysis during Pregnancy and the Postpartum Period

Contact Info

Product

Resources

About