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Dear Editor, Acute kidney injury (AKI) carries high mortality and morbidity [1, 2]. Two studies recently suggested the potential benefit of renin-angiotensin system (RAS) blockers (angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs)) after AKI [3, 4]. The first one reported a lower mortality after 1 year of follow-up in patients receiving an ACEi or ARB after an episode of AKI (KDIGO stages 1 to 3) at ICU discharge (20/109 (18%) vs 153/502 (31%), p = 0.001) [3]. The second one was a retrospective cohort study including adults after an episode of AKI during hospital stay (with 18% only of ICU-patients and only 7% of KDIGO stage 3) [4]. It concluded that exposure to an RAS blocker within the first 6 months after hospital discharge was associated with a 15% decrease in all-cause mortality (HR, 0.85; 95%CI, 0.81–0.89). We performed an ancillary of the AKIKI trial [5], which included 619 ICU patients with severe AKI (KDIGO stage 3) in order to evaluate the potential effect of RAS blockers on long-term mortality. All patients discharged alive from ICU were included, and their long-term prognosis (2-year all-cause mortality) was assessed according to treatment with ACEi/ARB at ICU discharge using both univariate and multivariate analyses. Among 348 patients discharged alive from ICU, 45 (12.9%) received an ACEi/ARB at ICU discharge (see Table 1 for patient characteristics). Patients without ACEi/ARB were more severe as attested by a higher SAPS 3 (p = 0.02) and a higher rate of catecholamine infusion (p = 0.008) during AKI. However, 2-year all-cause mortality did not significantly differ between the two groups (12/45 (27%) with ACEi/ARB vs 55/303 (18%) without, p = 0.18). Mortality risk was not associated with non-prescription of ACEi/ ARB after adjustment for prognostic variables (p = 0.21) (Table 2).

Renin-angiotensin-aldosterone system blockers after KDIGO stage 3 acute kidney injury: use and impact on 2-year mortality in the AKIKI trial