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Angiotensin‐converting enzyme inhibitor usage and acute kidney injury: A secondary analysis of RENAL study outcomes
Author(s) -
Wang Amanda Y,
Bellomo Rinaldo,
Ninomiya Toshiharu,
Lo Serigne,
Cass Alan,
Jardine Meg,
Gallagher Martin
Publication year - 2014
Publication title -
nephrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.752
H-Index - 61
eISSN - 1440-1797
pISSN - 1320-5358
DOI - 10.1111/nep.12284
Subject(s) - medicine , renal replacement therapy , acute kidney injury , kidney disease , sepsis , proportional hazards model , cohort study , intensive care unit , angiotensin converting enzyme , cohort , multivariate analysis , blood pressure
Aim Acute kidney injury ( AKI ) is associated with increased mortality. While angiotensin‐converting enzyme inhibitors ( ACEI ) are known to slow progression of chronic kidney disease, their role in AKI remains unclear. Methods The Randomised Evaluation of Normal vs. Augmented Level Replacement Therapy ( RENAL ) study data were analysed according to ACEI use over time. The primary outcome was all‐cause mortality at 90 days following randomisation. Analyses used a multivariate C ox model adjusted for either baseline or for time‐dependent covariates, and a sensitivity analysis of patients surviving to at least the median time to ACEI initiation. Results Of the 1463 participants with available data on ACE inhibitors usage, 142 (9.7%) received ACEI at least once during study data collection. Participants treated with ACEI were older ( P = 0.02) and had less sepsis at baseline ( P < 0.001). ACEI use was significantly associated with lower mortality at 90 days ( HR 0.46, 95% CI 0.30‐0.71, P < 0.001), and an increase in renal replacement therapy‐free days ( P < 0.001), intensive care unit‐free days ( P < 0.001) and hospital free‐days ( P < 0.001) after adjusting for baseline covariates. Using the time‐dependent analysis, however, the effect of ACEI administration was not significant ( HR 0.78, 95% CI 0.51‐1.21, P = 0.3). The sensitivity analysis in day 8 survivors produced similar results. Conclusion In the RENAL study cohort, the use of ACEI during the study was not common and, after adjustment for time‐dependent covariates, was not significantly associated with reductions in mortality. Further assessment of the effect of ACEI use in AKI patients is needed.