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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: Arrhythmia

80 codes in list

Code Coding system Description Entity type List name
14AN.00 Read h/o: atrial fibrillation diagnostic res30: Arrhythmia
14AR.00 Read history of atrial flutter diagnostic res30: Arrhythmia
212R.00 Read atrial fibrillation resolved diagnostic res30: Arrhythmia
327..00 Read ecg: supraventricular arrhythmia diagnostic res30: Arrhythmia
3272 Read ecg: atrial fibrillation diagnostic res30: Arrhythmia
3273 Read ecg: atrial flutter diagnostic res30: Arrhythmia
328..00 Read ecg: ventricular arrhythmia diagnostic res30: Arrhythmia
3282 Read ecg: ventricular tachycardia diagnostic res30: Arrhythmia
328Z.00 Read ecg: ventricular arrhythmia nos diagnostic res30: Arrhythmia
662S.00 Read atrial fibrillation monitoring diagnostic res30: Arrhythmia
6A9..00 Read atrial fibrillation annual review diagnostic res30: Arrhythmia
7936A00 Read implant intravenous pacemaker for atrial fibrillation diagnostic res30: Arrhythmia
8CMW200 Read atrial fibrillation care pathway diagnostic res30: Arrhythmia
8HTy.00 Read referral to atrial fibrillation clinic diagnostic res30: Arrhythmia
9hF..00 Read exception reporting: atrial fibrillation quality indicators diagnostic res30: Arrhythmia
9hF1.00 Read excepted from atrial fibrillation qual indic: inform dissent diagnostic res30: Arrhythmia
9Os..00 Read atrial fibrillation monitoring administration diagnostic res30: Arrhythmia
9Os0.00 Read atrial fibrillation monitoring first letter diagnostic res30: Arrhythmia
9Os1.00 Read atrial fibrillation monitoring second letter diagnostic res30: Arrhythmia
9Os2.00 Read atrial fibrillation monitoring third letter diagnostic res30: Arrhythmia
9Os3.00 Read atrial fibrillation monitoring verbal invite diagnostic res30: Arrhythmia
9Os4.00 Read atrial fibrillation monitoring telephone invite diagnostic res30: Arrhythmia
G559.00 Read arrhythmogenic right ventricular cardiomyopathy diagnostic res30: Arrhythmia
G55A.11 Read tachycardia-induced cardiomyopathy diagnostic res30: Arrhythmia
G56..00 Read conduction disorders diagnostic res30: Arrhythmia
G56..11 Read conduction disorders of heart diagnostic res30: Arrhythmia
G567400 Read wolff-parkinson-white syndrome diagnostic res30: Arrhythmia
G56y.00 Read other conduction disorders diagnostic res30: Arrhythmia
G56y000 Read lown-ganong-levine syndrome diagnostic res30: Arrhythmia
G56zz00 Read conduction disorders nos diagnostic res30: Arrhythmia
G57..00 Read cardiac dysrhythmias diagnostic res30: Arrhythmia
G570.00 Read paroxysmal supraventricular tachycardia diagnostic res30: Arrhythmia
G570000 Read paroxysmal atrial tachycardia diagnostic res30: Arrhythmia
G570100 Read paroxysmal atrioventricular tachycardia diagnostic res30: Arrhythmia
G570200 Read paroxysmal junctional tachycardia diagnostic res30: Arrhythmia
G570300 Read paroxysmal nodal tachycardia diagnostic res30: Arrhythmia
G570z00 Read paroxysmal supraventricular tachycardia nos diagnostic res30: Arrhythmia
G571.00 Read paroxysmal ventricular tachycardia diagnostic res30: Arrhythmia
G57..11 Read cardiac arrhythmias diagnostic res30: Arrhythmia
G571.11 Read ventricular tachycardia diagnostic res30: Arrhythmia
G572.00 Read paroxysmal tachycardia unspecified diagnostic res30: Arrhythmia
G572000 Read essential paroxysmal tachycardia diagnostic res30: Arrhythmia
G572z00 Read paroxysmal tachycardia nos diagnostic res30: Arrhythmia
G573.00 Read atrial fibrillation and flutter diagnostic res30: Arrhythmia
G573000 Read atrial fibrillation diagnostic res30: Arrhythmia
G573100 Read atrial flutter diagnostic res30: Arrhythmia
G573200 Read paroxysmal atrial fibrillation diagnostic res30: Arrhythmia
G573300 Read non-rheumatic atrial fibrillation diagnostic res30: Arrhythmia
G573400 Read permanent atrial fibrillation diagnostic res30: Arrhythmia
G573500 Read persistent atrial fibrillation diagnostic res30: Arrhythmia
G573600 Read paroxysmal atrial flutter diagnostic res30: Arrhythmia
G573z00 Read atrial fibrillation and flutter nos diagnostic res30: Arrhythmia
G574.00 Read ventricular fibrillation and flutter diagnostic res30: Arrhythmia
G574100 Read ventricular flutter diagnostic res30: Arrhythmia
G574z00 Read ventricular fibrillation and flutter nos diagnostic res30: Arrhythmia
G576300 Read atrial premature depolarization diagnostic res30: Arrhythmia
G576400 Read junctional premature depolarization diagnostic res30: Arrhythmia
G576500 Read ventricular premature depolarization diagnostic res30: Arrhythmia
G57y.00 Read other cardiac dysrhythmias diagnostic res30: Arrhythmia
G57y600 Read nodal rhythm disorder diagnostic res30: Arrhythmia
G57y900 Read supraventricular tachycardia nos diagnostic res30: Arrhythmia
G57yA00 Read re-entry ventricular arrhythmia diagnostic res30: Arrhythmia
G57yz00 Read other cardiac dysrhythmia nos diagnostic res30: Arrhythmia
G57z.00 Read cardiac dysrhythmia nos diagnostic res30: Arrhythmia
Gyu5a00 Read [x]other specified cardiac arrhythmias diagnostic res30: Arrhythmia
I45.6 ICD-10 pre-excitation syndrome diagnostic res30: Arrhythmia
I47 ICD-10 paroxysmal tachycardia diagnostic res30: Arrhythmia
I47.0 ICD-10 re-entry ventricular arrhythmia diagnostic res30: Arrhythmia
I47.1 ICD-10 supraventricular tachycardia diagnostic res30: Arrhythmia
I47.2 ICD-10 ventricular tachycardia diagnostic res30: Arrhythmia
I47.9 ICD-10 paroxysmal tachycardia, unspecified diagnostic res30: Arrhythmia
I48 ICD-10 atrial fibrillation and flutter diagnostic res30: Arrhythmia
I49 ICD-10 other cardiac arrhythmias diagnostic res30: Arrhythmia
I49.0 ICD-10 ventricular fibrillation and flutter diagnostic res30: Arrhythmia
I49.1 ICD-10 atrial premature depolarization diagnostic res30: Arrhythmia
I49.2 ICD-10 junctional premature depolarization diagnostic res30: Arrhythmia
I49.3 ICD-10 ventricular premature depolarization diagnostic res30: Arrhythmia
I49.4 ICD-10 other and unspecified premature depolarization diagnostic res30: Arrhythmia
I49.5 ICD-10 sick sinus syndrome diagnostic res30: Arrhythmia
R00.0 ICD-10 tachycardia, unspecified diagnostic res30: Arrhythmia

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