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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: ESRD
146 codes in list
| Code | Coding system | Description | Entity type | List name | |||
|---|---|---|---|---|---|---|---|
| 14S2.00 | Read | h/o: kidney recipient | diagnostic | res30: ESRD | |||
| 14V2.00 | Read | h/o: renal dialysis | diagnostic | res30: ESRD | |||
| 14V2.11 | Read | h/o: kidney dialysis | diagnostic | res30: ESRD | |||
| 1Z14.00 | Read | chronic kidney disease stage 5 | diagnostic | res30: ESRD | |||
| 1Z1K.00 | Read | chronic kidney disease stage 5 with proteinuria | diagnostic | res30: ESRD | |||
| 1Z1K.11 | Read | ckd stage 5 with proteinuria | diagnostic | res30: ESRD | |||
| 1Z1L.00 | Read | chronic kidney disease stage 5 without proteinuria | diagnostic | res30: ESRD | |||
| 1Z1L.11 | Read | ckd stage 5 without proteinuria | diagnostic | res30: ESRD | |||
| 4I29.00 | Read | peritoneal dialysis sample | diagnostic | res30: ESRD | |||
| 4N0..00 | Read | dialysis fluid urea level | diagnostic | res30: ESRD | |||
| 4N2..00 | Read | dialysis fluid glucose level | diagnostic | res30: ESRD | |||
| 67P4100 | Read | discussion about kidney transplantation | diagnostic | res30: ESRD | |||
| 7A60.00 | Read | arteriovenous shunt | diagnostic | res30: ESRD | |||
| 7A60000 | Read | insertion of arteriovenous prosthesis | diagnostic | res30: ESRD | |||
| 7A60100 | Read | creation of arteriovenous fistula nec | diagnostic | res30: ESRD | |||
| 7A60111 | Read | creation of radial-cephalic fistula | diagnostic | res30: ESRD | |||
| 7A60112 | Read | creation of brachial-cephalic fistula | diagnostic | res30: ESRD | |||
| 7A60200 | Read | attention to arteriovenous shunt | diagnostic | res30: ESRD | |||
| 7A60300 | Read | removal of infected arteriovenous shunt | diagnostic | res30: ESRD | |||
| 7A60400 | Read | banding of arteriovenous fistula | diagnostic | res30: ESRD | |||
| 7A60500 | Read | thrombectomy of arteriovenous fistula | diagnostic | res30: ESRD | |||
| 7A60600 | Read | creation of graft fistula for dialysis | diagnostic | res30: ESRD | |||
| 7A60y00 | Read | other specified arteriovenous shunt | diagnostic | res30: ESRD | |||
| 7A60z00 | Read | arteriovenous shunt nos | diagnostic | res30: ESRD | |||
| 7A61100 | Read | repair of acquired arteriovenous fistula | diagnostic | res30: ESRD | |||
| 7A61111 | Read | ligation of acquired arteriovenous fistula | diagnostic | res30: ESRD | |||
| 7A61400 | Read | ligation of acquired arteriovenous fistula | diagnostic | res30: ESRD | |||
| 7A61900 | Read | ligation of arteriovenous dialysis fistula | diagnostic | res30: ESRD | |||
| 7A61A00 | Read | ligation of arteriovenous dialysis graft | diagnostic | res30: ESRD | |||
| 7B00.00 | Read | transplantation of kidney | diagnostic | res30: ESRD | |||
| 7B00100 | Read | transplantation of kidney from live donor | diagnostic | res30: ESRD | |||
| 7B00111 | Read | allotransplantation of kidney from live donor | diagnostic | res30: ESRD | |||
| 7B00200 | Read | transplantation of kidney from cadaver | diagnostic | res30: ESRD | |||
| 7B00211 | Read | allotransplantation of kidney from cadaver | diagnostic | res30: ESRD | |||
| 7B00212 | Read | cadaveric renal transplant | diagnostic | res30: ESRD | |||
| 7B00300 | Read | allotransplantation of kidney from cadaver heart-beating | diagnostic | res30: ESRD | |||
| 7B00400 | Read | allotransplantation kidney from cadaver heart non-beating | diagnostic | res30: ESRD | |||
| 7B00600 | Read | xenograft renal transplant | diagnostic | res30: ESRD | |||
| 7B00y00 | Read | other specified transplantation of kidney | diagnostic | res30: ESRD | |||
| 7B00z00 | Read | transplantation of kidney nos | diagnostic | res30: ESRD | |||
| 7B01500 | Read | transplant nephrectomy | diagnostic | res30: ESRD | |||
| 7B01511 | Read | excision of rejected transplanted kidney | diagnostic | res30: ESRD | |||
| 7B06300 | Read | exploration of renal transplant | diagnostic | res30: ESRD | |||
| 7B0F.00 | Read | interventions associated with transplantation of kidney | diagnostic | res30: ESRD | |||
| 7B0F100 | Read | pre-transplantation of kidney work-up, recipient | diagnostic | res30: ESRD | |||
| 7B0F300 | Read | post-transplantation of kidney examination, recipient | diagnostic | res30: ESRD | |||
| 7B0Fy00 | Read | os interventions associated with transplantation of kidney | diagnostic | res30: ESRD | |||
| 7B0Fz00 | Read | interventions associated with transplantation of kidney nos | diagnostic | res30: ESRD | |||
| 7L1A.00 | Read | compensation for renal failure | diagnostic | res30: ESRD | |||
| 7L1A000 | Read | renal dialysis | diagnostic | res30: ESRD | |||
| 7L1A011 | Read | thomas intravascular shunt for dialysis | diagnostic | res30: ESRD | |||
| 7L1A100 | Read | peritoneal dialysis | diagnostic | res30: ESRD | |||
| 7L1A.11 | Read | dialysis for renal failure | diagnostic | res30: ESRD | |||
| 7L1A200 | Read | haemodialysis nec | diagnostic | res30: ESRD | |||
| 7L1A300 | Read | haemofiltration | diagnostic | res30: ESRD | |||
| 7L1A400 | Read | automated peritoneal dialysis | diagnostic | res30: ESRD | |||
| 7L1A500 | Read | continuous ambulatory peritoneal dialysis | diagnostic | res30: ESRD | |||
| 7L1A600 | Read | peritoneal dialysis nec | diagnostic | res30: ESRD | |||
| 7L1Ay00 | Read | other specified compensation for renal failure | diagnostic | res30: ESRD | |||
| 7L1Az00 | Read | compensation for renal failure nos | diagnostic | res30: ESRD | |||
| 7L1B.00 | Read | placement ambulatory apparatus compensation renal failure | diagnostic | res30: ESRD | |||
| 7L1B000 | Read | insertion of ambulatory peritoneal dialysis catheter | diagnostic | res30: ESRD | |||
| 7L1B100 | Read | removal of ambulatory peritoneal dialysis catheter | diagnostic | res30: ESRD | |||
| 7L1B.11 | Read | placement ambulatory dialysis apparatus - compens renal fail | diagnostic | res30: ESRD | |||
| 7L1B200 | Read | flushing of peritoneal dialysis catheter | diagnostic | res30: ESRD | |||
| 7L1By00 | Read | placement ambulatory apparatus- compensate renal failure os | diagnostic | res30: ESRD | |||
| 7L1C.00 | Read | placement other apparatus for compensation for renal failure | diagnostic | res30: ESRD | |||
| 7L1C000 | Read | insertion of temporary peritoneal dialysis catheter | diagnostic | res30: ESRD | |||
| 7L1Cy00 | Read | placement other apparatus- compensate for renal failure os | diagnostic | res30: ESRD | |||
| 7L1Cz00 | Read | placement other apparatus- compensate for renal failure nos | diagnostic | res30: ESRD | |||
| 8L50.00 | Read | renal transplant planned | diagnostic | res30: ESRD | |||
| 9b8K.00 | Read | transplantation surgery | diagnostic | res30: ESRD | |||
| 9Ot5.00 | Read | predicted stage chronic kidney disease | diagnostic | res30: ESRD | |||
| G72C.00 | Read | ruptured aneurysm of dialysis vascular access | diagnostic | res30: ESRD | |||
| G72D.00 | Read | aneurysm of dialysis arteriovenous fistula | diagnostic | res30: ESRD | |||
| G72D100 | Read | aneurysm of needle site of dialysis arteriovenous fistula | diagnostic | res30: ESRD | |||
| G72D200 | Read | aneurysm of anastomotic site of dialysis av fistula | diagnostic | res30: ESRD | |||
| G760.00 | Read | acquired arteriovenous fistula | diagnostic | res30: ESRD | |||
| Gy1..00 | Read | stenosis of dialysis vascular access | diagnostic | res30: ESRD | |||
| Gy21.00 | Read | thrombosis of dialysis arteriovenous fistula | diagnostic | res30: ESRD | |||
| Gy3..00 | Read | occlusion of dialysis vascular access | diagnostic | res30: ESRD | |||
| Gy31.00 | Read | occlusion of dialysis arteriovenous fistula | diagnostic | res30: ESRD | |||
| Gy40.00 | Read | infection of dialysis arteriovenous graft | diagnostic | res30: ESRD | |||
| Gy41.00 | Read | infection of dialysis arteriovenous fistula | diagnostic | res30: ESRD | |||
| Gy51.00 | Read | haemorrhage of dialysis arteriovenous fistula | diagnostic | res30: ESRD | |||
| Gy60.00 | Read | rupture of dialysis arteriovenous graft | diagnostic | res30: ESRD | |||
| K050.00 | Read | end stage renal failure | diagnostic | res30: ESRD | |||
| K05..12 | Read | end stage renal failure | diagnostic | res30: ESRD | |||
| K055.00 | Read | chronic kidney disease stage 5 | diagnostic | res30: ESRD | |||
| K0B5.00 | Read | renal tubulo-interstitial disordrs in transplant rejectn | diagnostic | res30: ESRD | |||
| K0D..00 | Read | end-stage renal disease | diagnostic | res30: ESRD | |||
| Kyu1C00 | Read | [x]renal tubulo-interstitial disorders/transplant rejection | diagnostic | res30: ESRD | |||
| SP01500 | Read | mechanical complication of dialysis catheter | diagnostic | res30: ESRD | |||
| SP01700 | Read | mechanical complication of arterio-venous surgical fistula | diagnostic | res30: ESRD | |||
| SP05613 | Read | [x] peritoneal dialysis associated peritonitis | diagnostic | res30: ESRD | |||
| SP06B00 | Read | continuous ambulatory peritoneal dialysis associated perit | diagnostic | res30: ESRD | |||
| SP07G00 | Read | stenosis of arteriovenous dialysis fistula | diagnostic | res30: ESRD | |||
| SP07N00 | Read | arteriovenous fistula thrombosis | diagnostic | res30: ESRD | |||
| SP08011 | Read | det.ren.func.after ren.transpl | diagnostic | res30: ESRD | |||
| SP08300 | Read | kidney transplant failure and rejection | diagnostic | res30: ESRD | |||
| SP08J00 | Read | chronic rejection of renal transplant | diagnostic | res30: ESRD | |||
| SP08N00 | Read | unexplained episode of renal transplant dysfunction | diagnostic | res30: ESRD | |||
| SP08R00 | Read | renal transplant rejection | diagnostic | res30: ESRD | |||
| SP08T00 | Read | urological complication of renal transplant | diagnostic | res30: ESRD | |||
| SP08W00 | Read | vascular complication of renal transplant | diagnostic | res30: ESRD | |||
| SP0E.00 | Read | disorders associated with peritoneal dialysis | diagnostic | res30: ESRD | |||
| SP0G.00 | Read | anaphylactoid reaction due to haemodialysis | diagnostic | res30: ESRD | |||
| TA02000 | Read | accid cut,puncture,perf,h'ge - kidney dialysis | diagnostic | res30: ESRD | |||
| TA22.00 | Read | failure of sterile precautions during perfusion | diagnostic | res30: ESRD | |||
| TA22000 | Read | failure of sterile precautions during kidney dialysis | diagnostic | res30: ESRD | |||
| TB00100 | Read | kidney transplant with complication, without blame | diagnostic | res30: ESRD | |||
| TB00111 | Read | renal transplant with complication, without blame | diagnostic | res30: ESRD | |||
| TB11.00 | Read | kidney dialysis with complication, without blame | diagnostic | res30: ESRD | |||
| TB11.11 | Read | renal dialysis with complication, without blame | diagnostic | res30: ESRD | |||
| U612200 | Read | [x]failure sterile precautions dur kidney dialys/other perf | diagnostic | res30: ESRD | |||
| Z1A..00 | Read | dialysis training | diagnostic | res30: ESRD | |||
| Z1A1.00 | Read | peritoneal dialysis training | diagnostic | res30: ESRD | |||
| Z1A2.00 | Read | haemodialysis training | diagnostic | res30: ESRD | |||
| Z919.00 | Read | care of haemodialysis equipment | diagnostic | res30: ESRD | |||
| Z919100 | Read | priming haemodialysis lines | diagnostic | res30: ESRD | |||
| Z919300 | Read | reversing haemodialysis lines | diagnostic | res30: ESRD | |||
| Z91A.00 | Read | peritoneal dialysis bag procedure | diagnostic | res30: ESRD | |||
| ZV42000 | Read | [v]kidney transplanted | diagnostic | res30: ESRD | |||
| ZV45100 | Read | [v]renal dialysis status | diagnostic | res30: ESRD | |||
| ZV56.00 | Read | [v]aftercare involving intermittent dialysis | diagnostic | res30: ESRD | |||
| ZV56000 | Read | [v]aftercare involving extracorporeal dialysis | diagnostic | res30: ESRD | |||
| ZV56011 | Read | [v]aftercare involving renal dialysis nos | diagnostic | res30: ESRD | |||
| ZV56100 | Read | [v]preparatory care for dialysis | diagnostic | res30: ESRD | |||
| ZV56y00 | Read | [v]other specified aftercare involving intermittent dialysis | diagnostic | res30: ESRD | |||
| ZV56y11 | Read | [v]aftercare involving peritoneal dialysis | diagnostic | res30: ESRD | |||
| ZVu3G00 | Read | [x]other dialysis | diagnostic | res30: ESRD | |||
| I77.0 | ICD-10 | arteriovenous fistula, acquired | diagnostic | res30: ESRD | |||
| N16.5 | ICD-10 | renal tubulo-interstitial disorders in transplant rejection | diagnostic | res30: ESRD | |||
| N18.5 | ICD-10 | chronic kidney disease, stage 5 | diagnostic | res30: ESRD | |||
| T82.4 | ICD-10 | mechanical complication of vascular dialysis catheter | diagnostic | res30: ESRD | |||
| T86.1 | ICD-10 | kidney transplant failure and rejection | diagnostic | res30: ESRD | |||
| Y60.2 | ICD-10 | during kidney dialysis or other perfusion | diagnostic | res30: ESRD | |||
| Y61.2 | ICD-10 | during kidney dialysis or other perfusion | diagnostic | res30: ESRD | |||
| Y62.2 | ICD-10 | during kidney dialysis or other perfusion | diagnostic | res30: ESRD | |||
| Y84.1 | ICD-10 | kidney dialysis | diagnostic | res30: ESRD | |||
| Z49 | ICD-10 | care involving dialysis | diagnostic | res30: ESRD | |||
| Z49.0 | ICD-10 | preparatory care for dialysis | diagnostic | res30: ESRD | |||
| Z49.1 | ICD-10 | extracorporeal dialysis | diagnostic | res30: ESRD | |||
| Z49.2 | ICD-10 | other dialysis | diagnostic | res30: ESRD | |||
| Z94.0 | ICD-10 | kidney transplant status | diagnostic | res30: ESRD | |||
| Z99.2 | ICD-10 | dependence on renal dialysis | diagnostic | res30: ESRD |
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