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Research article:
Renin-angiotensin system blockade and risk of acute kidney injury: a population-based cohort study
Reference:
Kathryn E Mansfield, Dorothea Nitsch, Liam Smeeth, Krishnan Bhaskaran, Laurie A Tomlinson(2015) Renin-angiotensin system blockade and risk of acute kidney injury: a population-based cohort study. Submitted, doi:
- Link to article
- Abstract
- Objective: To investigate whether there is an association between use of ACE inhibitors (ACEI) and angiotensin receptor blockers (ARB), and risk of acute kidney injury (AKI). Design: A time-updated, new-user cohort study among people initiating common antihypertensives (ACEI/ARB, beta-blockers, calcium channel blockers and thiazide diuretics) in primary care between April 1997 and March 2014. Participants: Adults initiating antihypertensive drug treatment, with at least one year of registration prior to first prescription, identified from UK primary care practices contributing to the Clinical Practice Research Datalink and eligible for linkage to hospital records data from the Hospital Episode Statistics database. Main outcome measures: Incidence rate ratio (RR) for first episode of AKI during time exposed to ACEI/ARB compared to time unexposed, estimated using Poisson regression adjusted for age, sex, comorbidities, use of other antihypertensive drugs, and calendar period. Results: Among 570,443 participants with a median follow-up of 2.8 years (IQR 0.4 to 7) there were 15,004 first cases of AKI. The overall crude rate of AKI was 6.4/1,000 person years at risk (95% CI 6.30 to 6.50) but varied from 1.63 (1.43 to 1.86) to 662.53 (538.98 to 814.40) depending on, age, comorbidities, and other prescribed drugs. The adjusted RR of AKI during time exposed to ACEI/ARB compared to time unexposed was 1.18 (95% CI 1.13 to 1.23) which was attenuated to 1.12 (95% CI 1.08 to 1.17) after adjustment for non-thiazide diuretic therapy. There was an interaction for the risk of AKI between people using loop diuretics and ACEI/ARB. For those taking loop diuretics, the adjusted RR of AKI during time exposed to ACEI/ARB compared to time unexposed was 0.99 (95% CI 0.92 to 1.06) but it was 1.18 (95% CI 1.13 to 1.24) among people not-exposed to loop diuretics (p<0.001). Conclusions: Treatment with ACEI/ARB alone appears to be associated with a small increase in the rate of AKI which is largely seen among people with low absolute risk of AKI. Among people requiring loop diuretics, who have a high absolute risk of AKI, treatment with ACEI/ARB had no measurable association with AKI.
- Author for correspondence
- Kathryn Mansfield
- Email for correspondence
- kathryn.mansfield@lshtm.ac.uk
Code list: res30: Acute kidney injury
13 codes in list
| Code | Coding system | Description | Entity type | List name | |||
|---|---|---|---|---|---|---|---|
| N14 | ICD-10 | Drug- and heavy-metal-induced tubulo-interstitial and tubular conditions | diagnostic | res30: Acute kidney injury | |||
| N14.1 | ICD-10 | Nephropathy induced by other drugs, medicaments and biological substances | diagnostic | res30: Acute kidney injury | |||
| N14.2 | ICD-10 | Nephropathy induced by unspecified drug, medicament or biological substance | diagnostic | res30: Acute kidney injury | |||
| N17 | ICD-10 | Acute renal failure | diagnostic | res30: Acute kidney injury | |||
| N17.0 | ICD-10 | Acute renal failure with tubular necrosis | diagnostic | res30: Acute kidney injury | |||
| N17.1 | ICD-10 | Acute renal failure with acute cortical necrosis | diagnostic | res30: Acute kidney injury | |||
| N17.2 | ICD-10 | Acute renal failure with medullary necrosis | diagnostic | res30: Acute kidney injury | |||
| N17.8 | ICD-10 | Other acute renal failure | diagnostic | res30: Acute kidney injury | |||
| N17.9 | ICD-10 | Acute renal failure, unspecified | diagnostic | res30: Acute kidney injury | |||
| N19 | ICD-10 | Unspecified kidney failure | diagnostic | res30: Acute kidney injury | |||
| N99.0 | ICD-10 | Postprocedural renal failure | diagnostic | res30: Acute kidney injury | |||
| R34 | ICD-10 | Anuria and oliguria | diagnostic | res30: Acute kidney injury | |||
| R94.4 | ICD-10 | Abnormal results of kidney function studies | diagnostic | res30: Acute kidney injury |
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