Renin-angiotensin blockade is associated with increased mortality after vascular surgery

Railton, Craig; Wolpin, Jacob; Lam-McCulloch, Jenny; Belo, Susan

doi:10.1007/s12630-010-9330-4

Cited by 57 publications

(31 citation statements)

References 39 publications

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“…Some authors found that the use of an ACEI decreased the incidence of acute kidney injury (AKI), mortality, and septicemia in cardiac and vascular surgical patients . However, others found that in vascular and cardiac surgery there is increased mortality as well as increased incidence of postoperative AKI . A retrospective study of 10,000 coronary artery bypass graft patients found that ACEI was associated with increased inotropic support, AKI, mortality, and new onset atrial fibrillation .…”

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confidence: 99%

Angiotensin axis blockade, hypotension, and acute kidney injury in elective major orthopedic surgery

Nielson

Hennrikus

Lehman

et al. 2014

Journal of Hospital Medicine

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BACKGROUND:Patients presenting for surgery with angiotensin axis blockade (AAB) from therapy with either angiotensin-converting enzyme inhibitors or angiotensin receptor blockers experience an increased incidence of perioperative hypotension. Acute kidney injury (AKI) in patients receiving preoperative AAB has been demonstrated after lung, vascular, and cardiac surgery. However, there is little literature evaluating the hypotensive and renal effects of preoperative AAB and major orthopedic surgery.

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confidence: 99%

Angiotensin axis blockade, hypotension, and acute kidney injury in elective major orthopedic surgery

Nielson

Hennrikus

Lehman

et al. 2014

Journal of Hospital Medicine

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“…Railton et al . studied the outcome of AKI-D and observed a higher incidence of AKI-D with ACEi/ARB use compared to non-use in patients who underwent abdominal aortic aneurysm repair (4.6% vs. 0.8%; P value = 0.01) [47]. However, the number of patients (n = 883) and number of events (n = 24) were small [47].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2014

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BackgroundSome studies but not others suggest angiotensin converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB) use prior to major surgery associates with a higher risk of postoperative acute kidney injury (AKI) and death.MethodsWe conducted a large population-based retrospective cohort study of patients aged 66 years or older who received major elective surgery in 118 hospitals in Ontario, Canada from 1995 to 2010 (n = 237,208). We grouped the cohort into ACEi/ARB users (n = 101,494) and non-users (n = 135,714) according to whether the patient filled at least one prescription for an ACEi or ARB (or not) in the 120 days prior to surgery. Our study outcomes were acute kidney injury treated with dialysis (AKI-D) within 14 days of surgery and all-cause mortality within 90 days of surgery.ResultsAfter adjusting for potential confounders, preoperative ACEi/ARB use versus non-use was associated with 17% lower risk of post-operative AKI-D (adjusted relative risk (RR): 0.83; 95% confidence interval (CI): 0.71 to 0.98) and 9% lower risk of all-cause mortality (adjusted RR: 0.91; 95% CI: 0.87 to 0.95). Propensity score matched analyses provided similar results. The association between ACEi/ARB and AKI-D was significantly modified by the presence of preoperative chronic kidney disease (CKD) (P value for interaction < 0.001) with the observed association evident only in patients with CKD (CKD - adjusted RR: 0.62; 95% CI: 0.50 to 0.78 versus No CKD: adjusted RR: 1.00; 95% CI: 0.81 to 1.24).ConclusionsIn this cohort study, preoperative ACEi/ARB use versus non-use was associated with a lower risk of AKI-D, and the association was primarily evident in patients with CKD. Large, multi-centre randomized trials are needed to inform optimal ACEi/ARB use in the peri-operative setting.

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“…Patients with preoperative RAS blockade further had a higher 30-day mortality in a retrospective cohort analysis of 883 patients scheduled for elective open abdominal aneurysm repair [85]. Th is study, however, bears several methodological problems (8-year observation period, confounding co-morbidity, lack of data on withdrawal of ACE inhibitors on the day of surgery).…”

Section: Recent Evidencementioning

confidence: 99%

Minimizing cardiac risk in perioperative practice – interdisciplinary pharmacological approaches

Böck

Wiedermann

Motsch

et al. 2011

Wien Klin Wochenschr

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All the concepts described require an interdisciplinary approach in collaboration between operative physicians and physicians working in non-surgical disciplines like internal medicine, cardiology, and clinical pharmacology. The perioperative continuation of a pre-existing therapy with beta-blockers and other potentially cardioprotective agents like α(2)-agonists and statines is recommended. In the management of patients presenting for major surgery stratification of the perioperative risk is essential which considers both, invasiveness of the surgical procedure and conditions of the patient. Otherwise, side-effects might outweigh benefits of a potentially effective therapy as recently shown for the perioperative administration of beta-blockers that should be restricted to high-risk patients.

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Renin-angiotensin blockade is associated with increased mortality after vascular surgery

Abstract: Examination of 883 cases of AAA repair showed increased mortality associated with preoperative RAS blockade. A better understanding of perioperative pharmacology and physiology of RAS blockade is needed as well as future studies to identify causality.

Cited by 57 publications

References 39 publications

Angiotensin axis blockade, hypotension, and acute kidney injury in elective major orthopedic surgery

Angiotensin axis blockade, hypotension, and acute kidney injury in elective major orthopedic surgery

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

Minimizing cardiac risk in perioperative practice – interdisciplinary pharmacological approaches

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