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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: Serum creatinine tests
51 codes in list
| Code | Coding system | Description | Entity type | List name | |||
|---|---|---|---|---|---|---|---|
| 4....00 | Read | laboratory procedures | test | res30: Serum creatinine tests | |||
| 41...00 | Read | laboratory procedures -general | test | res30: Serum creatinine tests | |||
| 4....11 | Read | investigation-laboratory | test | res30: Serum creatinine tests | |||
| 4....12 | Read | test - laboratory | test | res30: Serum creatinine tests | |||
| 412..00 | Read | laboratory procedure performed | test | res30: Serum creatinine tests | |||
| 413..00 | Read | laboratory test requested | test | res30: Serum creatinine tests | |||
| 41B..00 | Read | laboratory test due | test | res30: Serum creatinine tests | |||
| 41BZ.00 | Read | laboratory test nos due | test | res30: Serum creatinine tests | |||
| 41G..00 | Read | laboratory administration procedures | test | res30: Serum creatinine tests | |||
| 41G3.00 | Read | specimen received in laboratory | test | res30: Serum creatinine tests | |||
| 41H..00 | Read | review of patient laboratory test report | test | res30: Serum creatinine tests | |||
| 44J..00 | Read | blood urea/renal function | test | res30: Serum creatinine tests | |||
| 44J3.00 | Read | serum creatinine | test | res30: Serum creatinine tests | |||
| 44J3000 | Read | serum creatinine abnormal | test | res30: Serum creatinine tests | |||
| 44J3100 | Read | serum creatinine low | test | res30: Serum creatinine tests | |||
| 44J3200 | Read | serum creatinine normal | test | res30: Serum creatinine tests | |||
| 44J3300 | Read | serum creatinine raised | test | res30: Serum creatinine tests | |||
| 44J3z00 | Read | serum creatinine nos | test | res30: Serum creatinine tests | |||
| 44JC.00 | Read | corrected plasma creatinine level | test | res30: Serum creatinine tests | |||
| 44JD.00 | Read | corrected serum creatinine level | test | res30: Serum creatinine tests | |||
| 44JF.00 | Read | plasma creatinine level | test | res30: Serum creatinine tests | |||
| 44JZ.00 | Read | blood urea/renal function nos | test | res30: Serum creatinine tests | |||
| 451..00 | Read | renal function tests | test | res30: Serum creatinine tests | |||
| 4511 | Read | renal function tests normal | test | res30: Serum creatinine tests | |||
| 4512 | Read | renal function tests abnormal | test | res30: Serum creatinine tests | |||
| 4515 | Read | differential renal function | test | res30: Serum creatinine tests | |||
| 4516 | Read | renal function tests borderline | test | res30: Serum creatinine tests | |||
| 4519 | Read | deteriorating renal function | test | res30: Serum creatinine tests | |||
| 451H.00 | Read | recovery of renal function | test | res30: Serum creatinine tests | |||
| 451Z.00 | Read | renal function test nos | test | res30: Serum creatinine tests | |||
| 4Q40.00 | Read | creatinine level | test | res30: Serum creatinine tests | |||
| 4Z...00 | Read | laboratory procedure nos | test | res30: Serum creatinine tests | |||
| 8A6..00 | Read | renal function monitoring | test | res30: Serum creatinine tests | |||
| 8H7P.11 | Read | refer to pathology laboratory | test | res30: Serum creatinine tests | |||
| 8HP..00 | Read | referral for laboratory tests | test | res30: Serum creatinine tests | |||
| 98F..00 | Read | reason for repeat laboratory test | test | res30: Serum creatinine tests | |||
| 9b0P.00 | Read | laboratory request | test | res30: Serum creatinine tests | |||
| 9b0Q.00 | Read | laboratory result | test | res30: Serum creatinine tests | |||
| 9mG..00 | Read | renal function monitoring invitation | test | res30: Serum creatinine tests | |||
| 9mG0.00 | Read | renal function monitoring invitation first letter | test | res30: Serum creatinine tests | |||
| 9N1Q.00 | Read | seen in diabetic clinic | test | res30: Serum creatinine tests | |||
| C345.00 | Read | gout due to impairment of renal function | test | res30: Serum creatinine tests | |||
| K060.11 | Read | impaired renal function | test | res30: Serum creatinine tests | |||
| K08..00 | Read | impaired renal function disorder | test | res30: Serum creatinine tests | |||
| K08y.00 | Read | other impaired renal function disorder | test | res30: Serum creatinine tests | |||
| K08y300 | Read | renal function impairment with growth failure | test | res30: Serum creatinine tests | |||
| K08yz00 | Read | other impaired renal function disorder nos | test | res30: Serum creatinine tests | |||
| K08z.00 | Read | impaired renal function disorder nos | test | res30: Serum creatinine tests | |||
| R144.00 | Read | [d]renal function test abnormal | test | res30: Serum creatinine tests | |||
| R1yz.11 | Read | [d]unexplained laboratory result | test | res30: Serum creatinine tests | |||
| ZV72600 | Read | [v]laboratory examination | test | res30: Serum creatinine tests |
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