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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: Cardiac failure

112 codes in list

Code Coding system Description Entity type List name
14A6.00 Read h/o: heart failure diagnostic res30: Cardiac failure
14AM.00 Read h/o: heart failure in last year diagnostic res30: Cardiac failure
1736 Read paroxysmal nocturnal dyspnoea diagnostic res30: Cardiac failure
1J60.00 Read suspected heart failure diagnostic res30: Cardiac failure
1O1..00 Read heart failure confirmed diagnostic res30: Cardiac failure
388D.00 Read new york heart assoc classification heart failure symptoms diagnostic res30: Cardiac failure
585f.00 Read echocardiogram shows left ventricular systolic dysfunction diagnostic res30: Cardiac failure
585g.00 Read echocardiogram shows left ventricular diastolic dysfunction diagnostic res30: Cardiac failure
661M500 Read heart failure self-management plan agreed diagnostic res30: Cardiac failure
662f.00 Read new york heart association classification - class i diagnostic res30: Cardiac failure
662g.00 Read new york heart association classification - class ii diagnostic res30: Cardiac failure
662h.00 Read new york heart association classification - class iii diagnostic res30: Cardiac failure
662i.00 Read new york heart association classification - class iv diagnostic res30: Cardiac failure
662p.00 Read heart failure 6 month review diagnostic res30: Cardiac failure
662T.00 Read congestive heart failure monitoring diagnostic res30: Cardiac failure
662W.00 Read heart failure annual review diagnostic res30: Cardiac failure
679W100 Read education about deteriorating heart failure diagnostic res30: Cardiac failure
679X.00 Read heart failure education diagnostic res30: Cardiac failure
67D4.00 Read heart failure information given to patient diagnostic res30: Cardiac failure
8B29.00 Read cardiac failure therapy diagnostic res30: Cardiac failure
8CeC.00 Read preferred place of care for next exacerbation heart failure diagnostic res30: Cardiac failure
8CL3.00 Read heart failure care plan discussed with patient diagnostic res30: Cardiac failure
8CMK.00 Read has heart failure management plan diagnostic res30: Cardiac failure
8CMW800 Read heart failure clinical pathway diagnostic res30: Cardiac failure
8H2S.00 Read admit heart failure emergency diagnostic res30: Cardiac failure
8HBE.00 Read heart failure follow-up diagnostic res30: Cardiac failure
8Hg8.00 Read discharge from practice nurse heart failure clinic diagnostic res30: Cardiac failure
8HgD.00 Read discharge from heart failure nurse service diagnostic res30: Cardiac failure
8HHb.00 Read referral to heart failure nurse diagnostic res30: Cardiac failure
8HHz.00 Read referral to heart failure exercise programme diagnostic res30: Cardiac failure
8Hk0.00 Read referred to heart failure education group diagnostic res30: Cardiac failure
8HTL.00 Read referral to heart failure clinic diagnostic res30: Cardiac failure
8HTL000 Read referral to rapid access heart failure clinic diagnostic res30: Cardiac failure
8IE0.00 Read referral to heart failure education group declined diagnostic res30: Cardiac failure
8IE1.00 Read referral to heart failure exercise programme declined diagnostic res30: Cardiac failure
9h1..00 Read exception reporting: lvd quality indicators diagnostic res30: Cardiac failure
9h11.00 Read excepted from lvd quality indicators: patient unsuitable diagnostic res30: Cardiac failure
9h12.00 Read excepted from lvd quality indicators: informed dissent diagnostic res30: Cardiac failure
9hH..00 Read exception reporting: heart failure quality indicators diagnostic res30: Cardiac failure
9hH0.00 Read excepted heart failure quality indicators: patient unsuitabl diagnostic res30: Cardiac failure
9hH1.00 Read excepted heart failure quality indicators: informed dissent diagnostic res30: Cardiac failure
9N0k.00 Read seen in heart failure clinic diagnostic res30: Cardiac failure
9N2p.00 Read seen by community heart failure nurse diagnostic res30: Cardiac failure
9N4s.00 Read did not attend practice nurse heart failure clinic diagnostic res30: Cardiac failure
9N4w.00 Read did not attend heart failure clinic diagnostic res30: Cardiac failure
9N6T.00 Read referred by heart failure nurse specialist diagnostic res30: Cardiac failure
9On..00 Read left ventricular dysfunction monitoring administration diagnostic res30: Cardiac failure
9On0.00 Read left ventricular dysfunction monitoring first letter diagnostic res30: Cardiac failure
9On1.00 Read left ventricular dysfunction monitoring second letter diagnostic res30: Cardiac failure
9On2.00 Read left ventricular dysfunction monitoring third letter diagnostic res30: Cardiac failure
9On3.00 Read left ventricular dysfunction monitoring verbal invite diagnostic res30: Cardiac failure
9On4.00 Read left ventricular dysfunction monitoring telephone invite diagnostic res30: Cardiac failure
9Or..00 Read heart failure monitoring administration diagnostic res30: Cardiac failure
9Or0.00 Read heart failure review completed diagnostic res30: Cardiac failure
9Or1.00 Read heart failure monitoring telephone invite diagnostic res30: Cardiac failure
9Or2.00 Read heart failure monitoring verbal invite diagnostic res30: Cardiac failure
9Or3.00 Read heart failure monitoring first letter diagnostic res30: Cardiac failure
9Or4.00 Read heart failure monitoring second letter diagnostic res30: Cardiac failure
9Or5.00 Read heart failure monitoring third letter diagnostic res30: Cardiac failure
G1yz100 Read rheumatic left ventricular failure diagnostic res30: Cardiac failure
G210.00 Read malignant hypertensive heart disease diagnostic res30: Cardiac failure
G210100 Read malignant hypertensive heart disease with ccf diagnostic res30: Cardiac failure
G211100 Read benign hypertensive heart disease with ccf diagnostic res30: Cardiac failure
G21z100 Read hypertensive heart disease nos with ccf diagnostic res30: Cardiac failure
G230.00 Read malignant hypertensive heart and renal disease diagnostic res30: Cardiac failure
G232.00 Read hypertensive heart&renal dis wth (congestive) heart failure diagnostic res30: Cardiac failure
G234.00 Read hyperten heart&renal dis+both(congestv)heart and renal fail diagnostic res30: Cardiac failure
G400.00 Read acute cor pulmonale diagnostic res30: Cardiac failure
G41z.11 Read chronic cor pulmonale diagnostic res30: Cardiac failure
G554000 Read congestive cardiomyopathy diagnostic res30: Cardiac failure
G554011 Read congestive obstructive cardiomyopathy diagnostic res30: Cardiac failure
G557100 Read beriberi heart disease diagnostic res30: Cardiac failure
G58..00 Read heart failure diagnostic res30: Cardiac failure
G580.00 Read congestive heart failure diagnostic res30: Cardiac failure
G580000 Read acute congestive heart failure diagnostic res30: Cardiac failure
G580100 Read chronic congestive heart failure diagnostic res30: Cardiac failure
G580.11 Read congestive cardiac failure diagnostic res30: Cardiac failure
G580.12 Read right heart failure diagnostic res30: Cardiac failure
G580.13 Read right ventricular failure diagnostic res30: Cardiac failure
G580.14 Read biventricular failure diagnostic res30: Cardiac failure
G580200 Read decompensated cardiac failure diagnostic res30: Cardiac failure
G580300 Read compensated cardiac failure diagnostic res30: Cardiac failure
G580400 Read congestive heart failure due to valvular disease diagnostic res30: Cardiac failure
G581.00 Read left ventricular failure diagnostic res30: Cardiac failure
G581000 Read acute left ventricular failure diagnostic res30: Cardiac failure
G58..11 Read cardiac failure diagnostic res30: Cardiac failure
G581.11 Read asthma - cardiac diagnostic res30: Cardiac failure
G581.13 Read impaired left ventricular function diagnostic res30: Cardiac failure
G582.00 Read acute heart failure diagnostic res30: Cardiac failure
G583.00 Read heart failure with normal ejection fraction diagnostic res30: Cardiac failure
G583.11 Read hfnef - heart failure with normal ejection fraction diagnostic res30: Cardiac failure
G583.12 Read heart failure with preserved ejection fraction diagnostic res30: Cardiac failure
G584.00 Read right ventricular failure diagnostic res30: Cardiac failure
G58z.00 Read heart failure nos diagnostic res30: Cardiac failure
G58z.11 Read weak heart diagnostic res30: Cardiac failure
G58z.12 Read cardiac failure nos diagnostic res30: Cardiac failure
G5y4z00 Read post cardiac operation heart failure nos diagnostic res30: Cardiac failure
G5yy900 Read left ventricular systolic dysfunction diagnostic res30: Cardiac failure
G5yyA00 Read left ventricular diastolic dysfunction diagnostic res30: Cardiac failure
G5yyB00 Read right ventricular diastolic dysfunction diagnostic res30: Cardiac failure
Q48y100 Read congenital cardiac failure diagnostic res30: Cardiac failure
R2y1000 Read [d]cardiorespiratory failure diagnostic res30: Cardiac failure
SP11111 Read heart failure as a complication of care diagnostic res30: Cardiac failure
ZRad.00 Read new york heart assoc classification heart failure symptoms diagnostic res30: Cardiac failure
I11.0 ICD-10 hypertensive heart disease with (congestive) heart failure diagnostic res30: Cardiac failure
I13.0 ICD-10 hypertensive heart and renal disease with (congestive) heart failure diagnostic res30: Cardiac failure
I13.2 ICD-10 hypertensive heart and renal disease with both (congestive) heart failure and renal failure diagnostic res30: Cardiac failure
I26.0 ICD-10 pulmonary embolism with mention of acute cor pulmonale diagnostic res30: Cardiac failure
I50 ICD-10 heart failure diagnostic res30: Cardiac failure
I50.0 ICD-10 congestive heart failure diagnostic res30: Cardiac failure
I50.1 ICD-10 left ventricular failure diagnostic res30: Cardiac failure
I50.9 ICD-10 heart failure, unspecified diagnostic res30: Cardiac failure

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