Incidence and Predictors of Development of Acute Renal Failure Related to Treatment of Congestive Heart Failure with ACE Inhibitors

Abstract

Background/Aims: Recent studies have shown high rates of morbimortality associated with hyperkalemia in congestive heart failure (CHF) patients treated with angiotensin-converting enzyme inhibitors (ACEI) plus spironolactone and the best predictor of this electrolytic disorder was a decrease in renal function. We aim to identify the incidence and predictors of acute renal failure (ARF) related to treatment with ACEI associated or not with spironolactone. Methods: We conducted a cohort study and followed 114 consecutive cases of CHF patients treated with ACEI at admission to a University Hospital. We performed measurements of serum creatinine and potassium levels three times a week, and systolic and diastolic blood pressures every 8 h, daily. Results: Among 114 patients, 25% developed ARF, 15% hyperkalemia and 3% severe hyperkalemia. Predictors of ARF were a decrease in average blood pressure 25 mm Hg (OR 18.2; 95% CI: 6.2, 53.5); class IV CHF (OR 4.7; 95% CI: 1.7, 12.7), diabetes (OR 2.6; 95% CI: 1.1, 6.4) and hypertension (OR 3.0; 95% CI: 1.2, 7.4). Conclusions: ARF and hyperkalemia are common complications in CHF patients after treatment with ACEI. Diabetic, hypertensive and class IV CHF patients who experienced a decrease in average blood pressure 25 mm Hg were more susceptible to ARF.

Drug-induced acute kidney injury in the critically ill adult: Recognition and prevention strategies

“…As a result, the transglomerular pressure decreases, leading to a reduction in glomerular filtration rate and a decline in urine production. Patients at most risk for AKI are those with decreased renal perfusion (heart failure, volume depletion) (19). Patients with bilateral renal artery stenosis are also at increased risk (20,21).…”

Hyperkalemia and Acute Kidney Injury with Spironolactone Use Among Patients with Heart Failure

“…4 Nevertheless, any benefits associated with spironolactone must be weighed in the context of its known serious risks, specifically hyperkalemia and acute kidney injury (AKI). 1,[5][6][7][8][9][10][11][12][13] Most prior clinical trials of spironolactone focused on patient populations with relatively preserved kidney function. In both RALES and TOPCAT, patients with estimated glomerular filtration rate (eGFR) less than 30 mL/min per 1.73 m 2 , serum creatinine (SCr) greater than 2.5 mg/dL, and serum potassium (K) greater than 5.0 mEq/L were excluded.…”

Progression to stage 3 and 4 chronic kidney disease and risk factor stratification following endovascular aortic aneurysm repair

“…Perioperative ACE inhibitors have also been shown to affect renal function, 14 especially in patients with congestive heart failure as shown by Cruz et al. 22 The fact that those medications influenced only advancement toward stage 3 may have been partially blunted by the perioperative renal protection protocol that mandated holding nephrotoxic medications in patients with eGFR < 60 ml/min/1.73 m 2 . Increased blood loss was also significant but to a much lesser degree than history of diabetes or use of ACE inhibitors.…”