Prescription of renin–angiotensin system blockers and risk of acute kidney injury: a population-based cohort study

Mansfield, Kathryn E.; Nitsch, Dorothea; Smeeth, Liam; Bhaskaran, Krishnan; Tomlinson, Laurie

doi:10.1136/bmjopen-2016-012690

Cited by 79 publications

(80 citation statements)

References 32 publications

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“…Patients concomitantly prescribed diuretics and NSAIDSs are at greater risk of AKI, as observed by others . Amongst incident patients prescribed ACEi/ARB medication, we found a similar rate of AKI episodes associated with a hospital admission to a previous cohort of ACEi/ARB users . The incidence of biochemical AKI based on internationally recognised creatinine change criteria was approximately twofold higher than has previously been reported for the general population in the Grampian region …”

Section: Discussionsupporting

confidence: 83%

“…There would be biases in selecting a group of patients commenced on an alternative class of antihypertensive medication such as calcium channel blockers. This has been explored in other studies with only small increases of AKI incidence with ACEi/ARB in comparison to patients exposed to antihypertensive regimes not including ACEi/ARB . In the case of HF, it would be unusual not to be treated with ACEi/ARB therapy.…”

Section: Discussionmentioning

confidence: 99%

“…However, the degree to which RASi are causal for AKI in this setting is debated . AKI in association with RASi therapy is common and the incidence is rising, either due to more widespread prescribing of these agents in patients at risk of AKI, or alternatively due to better awareness of AKI, including coding AKI as a diagnosis during hospitalisation …”

Section: Introductionmentioning

confidence: 99%

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Risk factors associated with biochemically detected and hospitalised acute kidney injury in patients prescribed renin angiotensin system inhibitors

Mark

Papworth

Ramparsad

et al. 2020

Brit J Clinical Pharma

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Aims: Therapy with angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) is a mainstay of treatment for heart failure (HF), diabetes mellitus (DM) and chronic kidney disease (CKD). These agents have been associated with development of acute kidney injury (AKI) during intercurrent illness. Risk factors for AKI in patients prescribed ACEi/ARB therapy are not well described. Methods:We captured the incidence of AKI in patients commencing ACEi/ARB during 2009-2015 using anonymised patient records. Hospital-coded AKI was defined from hospital episode statistics; biochemical AKI was ascertained from laboratory data. Risk factors for biochemically detected and hospitalised AKI were investigated. Results:Of 61,318 patients prescribed ACEi/ARB, with 132 885 person years (py) follow-up, there were 1070 hospitalisations with AKI as a diagnosis recorded and a total of 4645 AKI events, including AKI episodes indicated by biochemical KDIGObased creatinine change criteria. Incidence of any AKI event was 35.0 per 1000-py, hospital-coded AKI was 7.8 per 1000-py and biochemical AKI was 33.7 per 1000-py.Independent risk factors in a multivariable model for hospital-coded AKI events were age, male gender, HF, diabetes, cerebrovascular disease, lower estimated glomerular filtration rate, socioeconomic deprivation, diuretic or non-steroidal anti-inflammatory use (all P < 0.001). Conclusion:In patients prescribed ACEi/ARB, the highest risk of AKI is associated with conditions which are considered strong evidence-based indications for their prescription. Socio-economic status is an under-reported risk factor for AKI with these agents. Strategies targeted at prevention of AKI may be of benefit, such as enhanced awareness based on higher risk comorbidities. K E Y W O R D Sacute kidney injury, angiotensin converting enzyme inhibitor, angiotensin receptor blocker, chronic kidney disease, heart failure

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Risk factors associated with biochemically detected and hospitalised acute kidney injury in patients prescribed renin angiotensin system inhibitors

Mark

Papworth

Ramparsad

et al. 2020

Brit J Clinical Pharma

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“…Moreover, we have demonstrated that C20 suppressed renin expression under normal levels of calcium and phosphorus in vivo, which further indicated the beneficial role of C20 on renal protection. The down-regulation of renin expression markedly ameliorated the renal and cardiomyocyte injury [39,42].…”

Section: Discussionmentioning

confidence: 99%

Riligustilide Attenuated Renal Injury by the Blockade of Renin

Kong

Han

et al. 2018

Cell Physiol Biochem

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Background/Aims: Nephropathy related with renin can be alleviated with ACE-inhibitors or AT1R blockers, whereas they might be ineffective after long-term administration because of a feedback production of enhanced renin. Therefore, it is urgent to develop a new category of anti-nephropathy medicine directly targeting renin. Riligustilide (C20), originally isolated from the Chinese herb Ligusticumporteri, a rhizome, was confirmed effective against many diseases. Methods: The therapeutic effect of C20 on renal injury and its underlying mechanism were investigated in three different nephrotic models, which were spontaneously hypertension rats (SHR) model, diabetic nephropathy in BTBR ob/ob mice model and 5/6-nephrectomized (5/6NX) rats model. Results: The intensity of kidney fibrosis was extensively decreased in the C20-treated rats compared to the vehicle animals. C20 significantly alleviated renal injury much more in 5/6 NX rats than in vehicle group. The rats in 5/6 NX without administrated C20 developed albuminuria earlier with more severe symptoms. Additionally, our findings showed that C20 down-regulated the renin expression and relocation of CREB-CBP complex in vivo and in vitro. Conclusion: C20 plays importantly reno-protective roles most likely through the relocation of CREB-CBP complex.

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“…The most robust observational evidence comes from population-based cohort studies where baseline comorbidities and other drug use can be accounted for. Recent studies of this type have shown weak or no association between ACEI/ARB use and AKI (3,4). However, patients with comorbidities for which ACEIs/ARBs are indicated (e.g., diabetes, HFrEF, and CKD) are at high risk of AKI, with rates increasing as the list of comorbidities grows (3).…”

mentioning

confidence: 99%