Association Between Dose Reduction Of Renin-Angiotensin-Aldosterone System Inhibitors Before Coronary Artery Angiography And Acute Kidney Injury: A Propensity Matched Study

Abstract

Background: Acute kidney injury (AKI), which is commonly observed in hospitalized patients, increases mortality. Although renin-angiotensin-aldosterone system inhibitors (RAASis) and coronary artery angiography (CAG) are reported to be risk factors for AKI, whether dose reduction of RAASis can prevent AKI after CAG remains unknown. The objective of this study was to investigate the association between dose reduction of RAASis and AKI.Methods: In this retrospective propensity score (PS)-matched cohort of patients with an estimated glomerular filtration rate (eGFR) of 15-60 ml/min/1.73 m2 who were prescribed RAASis, we examined the impact of dose reduction of RAASis on the development of AKI after CAG with the RWD database, which includes 20 million patients from 190 hospitals in Japan. The exposure of interest was the presence of a dose reduction in RAASis within the 3 days before CAG was performed. The propensity score was derived from 19 baseline characteristics using a logistic regression model.Results: We identified 3,289 patients who were prescribed RAASis at least one month before admission and underwent CAG. Six hundred seventy-four patients had a dose reduction 3 days prior to undergoing CAG, and 2,640 patients did not. AKI was observed in 42 (4.7%) patients in the reduction group and 121 (5.1%) patients in the control group. There was no significant difference in the primary outcome between the two groups in the PS-matched cohort (OR: 1.00, 95% CI: 0.69-1.47).Conclusions: A reduction in the dose of RAASis did not prevent the development of AKI among patients undergoing CAG.