Renin–angiotensin system blocker use and the risk of acute kidney injury after colorectal cancer surgery: a population-based cohort study

Slagelse, Charlotte; Gammelager, Henrik; Iversen, Lene Hjerrild; Liu, Kathleen D.; Sørensen, Henrik Toft; Christiansen, Christian Fynbo

doi:10.1136/bmjopen-2019-032964

Cited by 4 publications

(5 citation statements)

References 45 publications

(70 reference statements)

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“…Recent evidence has shown that the use of ACEIs/ARBs is associated with an increased risk of postoperative AKI after surgical valve replacement and colorectal cancer surgery. [ 28 , 29 ] A previous study on EVAR with a cohort of 149 patients has reported that ARBs use is a risk factor for AKI after EVAR, while ACEIs use does not increase the risk. [ 15 ] However, in the present study, ACEIs or ARBs were combined as one variable because the usage rates of ACEIs and ARBs are relatively low, and both ACEIs and ARBs are targeted at the renin-angiotensin system (RAS).…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers increases the risk of postoperative acute kidney injury after elective endovascular abdominal aortic aneurysm repair

Xiang

Liu²,

Zhao³

et al. 2022

Chinese Medical Journal

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Background: Endovascular abdominal aortic aneurysm repair (EVAR) is the major treatment for abdominal aortic aneurysm (AAA); however, EVAR still carries a considerable risk of acute kidney injury (AKI). The present study aimed to investigate the risk factors for AKI after elective EVAR procedures. Methods: This was a retrospective observational study. Eligible patients who underwent EVAR from September 2011 to March 2019 in West China Hospital were included. The primary outcome was the occurrence of AKI within two days after EVAR, which was defined by the Kidney Disease Improving Global Outcomes Clinical Practice Guideline. Demographics, comorbidities, medications, laboratory tests, anatomical parameters of AAA, and relative operative details were collected as variables. Univariable and multivariable logistic regression analyses were applied to identify the risk factors among variables, and covariate interactions were further assessed. Results: A total of 679 eligible patients were included. The incidence of postoperative AKI was 8.2% (56/679) in the whole cohort, and it was associated with a lower 5-year survival rate (63.5% vs. 80.9%; x 2 = 4.10; P = 0.043). The multivariable logistic regression showed that chronic kidney disease (OR, 5.06; 95% CI: 1.43-17.95; P = 0.012), angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs) (OR, 2.60; 95% CI: 1.17-5.76; P = 0.019), and short neck (OR, 2.85; 95% CI: 1.08-7.52; P = 0.035) were independent risk factors for postoperative AKI. In the covariate interaction analysis, the effect of ACEIs/ARBs use on postoperative AKI was similar across all subgroups (P > 0.05), thereby suggesting a robust effect of ACEIs/ ARBs use in all patients undergoing elective endovascular abdominal aortic aneurysm repair. Conclusions: Postoperative AKI was associated with lower survival rate, and the use of ACEIs/ARBs was the only adjustable independent risk factor. Clinicians should consider withdrawing ACEIs/ARBs in high-risk patients undergoing elective endovascular abdominal aortic aneurysm repair to prevent postoperative AKI.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers increases the risk of postoperative acute kidney injury after elective endovascular abdominal aortic aneurysm repair

Xiang

Liu²,

Zhao³

et al. 2022

Chinese Medical Journal

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“…The latter study also suggested that the number of prescribed medications was an independent risk factor 6. Furthermore, use of angiotensin receptor blockers (ARBs) increased the risk of postoperative AKI following colorectal surgery 12. A large-scale cohort study conducted in non-orthopaedic patients found a significant association between the use of diuretics and the development of AKI following major surgery 13.…”

Section: Introductionmentioning

confidence: 99%

“… 6 Furthermore, use of angiotensin receptor blockers (ARBs) increased the risk of postoperative AKI following colorectal surgery. 12 A large-scale cohort study conducted in non-orthopaedic patients found a significant association between the use of diuretics and the development of AKI following major surgery. 13 In addition, the impact of perioperative non-steroidal anti-inflammatory drug (NSAID) use on the development of postoperative AKI remains under question with unequivocal findings from a recent systematic review.…”

Section: Introductionmentioning

confidence: 99%

Reducing incidence of postoperative acute kidney injury in trauma and orthopaedics patients: a quality improvement project

et al. 2023

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BackgroundAcute kidney injury (AKI) is a common postoperative complication which increases morbidity and mortality. This quality improvement project aimed to implement measures targeting known risk factors to decrease the incidence of postoperative AKI in trauma and orthopaedics (T&O) patients.MethodsData were collected across three six-month to 7-month cycles between 2017 and 2020, analysing all elective and emergency T&O operated patients within a single NHS Trust (n=714, 1008 and 928, respectively). Patients who developed a postoperative AKI were identified using biochemical criteria and data were collected on known AKI risk factors, including use of nephrotoxic medications, and patient outcomes. In the final cycle, the same variables were collected for patients without AKI. Between cycles, measures implemented included: preoperative and postoperative medication reconciliation aiming to stop nephrotoxic medications, orthogeriatrician review of high-risk patients and junior doctor teaching on fluid therapy. Statistical analysis was undertaken to determine the incidence of postoperative AKI across cycles, prevalence of risk factors and impact on length of hospital stay and postoperative mortality.ResultsThere was a statistically significant decrease in postoperative AKI incidence from 4.27% (43 of 1008 patients) in cycle 2 to 2.05% (19 of 928) in cycle 3 (p=0.006), with a notable decrease in use of nephrotoxic medications. Significant predictors for the development of postoperative AKI included use of diuretics and receiving multiple nephrotoxic drug classes. Development of postoperative AKI significantly increased length of hospital stay by 7.11 days on average (95% CI: 4.84 to 9.38 days, p<0.001) and risk of 1-year postoperative mortality (OR 3.22, 95% CI: 1.03 to 10.55, p=0.046).ConclusionThis project demonstrates that a multifaceted approach targeting modifiable risk factors can reduce incidence of postoperative AKI in T&O patients, which may lead to reduced length of hospital stay and postoperative mortality.

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“…AKI affects approximately 1.3 million US adults annually. 1,2 Because of their association with AKI, [3][4][5][6][7] angiotensin-converting enzyme inhibitors (ACEis) and angiotensin II receptor blockers (ARBs) are frequently stopped or temporarily withheld in the setting of AKI. [8][9][10] Yet, hypertension and albuminuria, both treated by ACEis/ARBs, have been observed to worsen after AKI, [11][12][13] suggesting that the relative benefits from ACEi/ARB use may actually increase with the occurrence of AKI.…”

Section: Introductionmentioning

confidence: 99%

Renin–Angiotensin–Aldosterone System Blockade after AKI with or without Recovery among US Veterans with Diabetic Kidney Disease

Murphy,

Wolfson,

Reule

et al. 2023

JASN

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Background Optimal use of angiotensin-converting enzyme inhibitors (ACEi) or angiotensin II receptor blockers (ARBs) after acute kidney injury (AKI) is uncertain. Methods Using data derived from electronic medical records, we sought to estimate the association between ACEi/ARB use after AKI and mortality in US military veterans with indications for such treatment (diabetes and proteinuria), while accounting for AKI recovery. We used ACEi/ARB treatment after hospitalization with AKI (defined as serum creatinine ≥50% above baseline concentration) as a time-varying exposure in Cox models. The outcome was all-cause mortality. Recovery was defined as return to ≤110% of baseline creatinine. A secondary analysis focused on ACEi/ARB use relative to AKI recovery (before versus after). Results Among 54,735 veterans with AKI, 31,146 deaths occurred over 2.3 years of median follow-up. About 57% received an ACEi/ARB <3 months after hospitalization. In multivariate analysis with time-varying recovery, post-AKI ACEi/ARB use was associated with lower risk of mortality (adjusted hazard ratio [aHR], 0.74; 95% confidence interval [95% CI], 0.72 to 0.77)). The association between ACEi/ARB and mortality varied over time, with lower mortality risk associated with earlier initiation (P for interaction with time <0.001). In secondary analysis, compared with those with neither recovery nor ACEi/ARB use, risk for mortality was lower in those with recovery without ACEi/ARB (aHR, 0.90; 95% CI, 0.87 to 0.94), those without recovery with ACEi/ARB use (aHR, 0.69; 95% CI, 0.66 to 0.72), and in those with ACEi/ARB use after recovery (aHR, 0.70; 95% CI, 0.67 to 0.73). Conclusions This study demonstrated lower mortality associated with ACEi/ARB use in veterans with diabetes, proteinuria, and AKI, regardless of recovery. Results favored earlier ACEi/ARB initiation.

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Renin–angiotensin system blocker use and the risk of acute kidney injury after colorectal cancer surgery: a population-based cohort study

Cited by 4 publications

References 45 publications

Use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers increases the risk of postoperative acute kidney injury after elective endovascular abdominal aortic aneurysm repair

Use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers increases the risk of postoperative acute kidney injury after elective endovascular abdominal aortic aneurysm repair

Reducing incidence of postoperative acute kidney injury in trauma and orthopaedics patients: a quality improvement project

Renin–Angiotensin–Aldosterone System Blockade after AKI with or without Recovery among US Veterans with Diabetic Kidney Disease

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