Impact of angiotensin-converting enzyme inhibitors or receptor blockers on post-ICU discharge outcome in patients with acute kidney injury

Etienne Gayat, Alexa Hollinger, Alain Cariou, Nicolas Deye, Antoine Vieillard-Baron, Samir Jaber, Benjamin G Chousterman, Qin Lu, Pierre François Laterre, Xavier Monnet, Michael Darmon, Marc Leone, Bertrand Guidet, Romain Sonneville, Jean-Yves Lefrant, Marie-Céline Fournier, Matthieu Resche-Rigon, Alexandre Mebazaa, Matthieu Legrand, FROG-ICU investigators, Etienne Gayat, Alexa Hollinger, Alain Cariou, Nicolas Deye, Antoine Vieillard-Baron, Samir Jaber, Benjamin G Chousterman, Qin Lu, Pierre François Laterre, Xavier Monnet, Michael Darmon, Marc Leone, Bertrand Guidet, Romain Sonneville, Jean-Yves Lefrant, Marie-Céline Fournier, Matthieu Resche-Rigon, Alexandre Mebazaa, Matthieu Legrand, FROG-ICU investigators

Abstract

Purpose: Acute kidney injury (AKI) is associated with the activation of the renin-angiotensin system. Whether angiotensin-converting enzyme inhibitors (ACEi) or angiotensin-receptor blockers (ARB) improve outcome in patients recovering from AKI remains unexplored. The purpose was to investigate the association between prescription of ACEi/ARB at intensive care unit (ICU) discharge and 1-year outcome in patients recovering from AKI.

Methods: Association between ACEi/ARB and 1-year mortality rate was explored in 1551 patients discharged from 21 European ICUs in an observational cohort. One-year all-cause mortality after ICU discharge was the primary endpoint. AKI was defined using the kidney disease improvement global outcome definition. Propensity score matching was used to consider the probability to receive ACEi/ARB at ICU discharge and included chronic heart failure, ACEi/ARB on ICU admission, Charlson Comorbidity Index, age, diabetes mellitus, chronic kidney disease, estimated glomerular filtration rate and arterial blood pressure at ICU discharge vasopressors and renal replacement therapy.

Results: Overall, 1-year mortality was 28 and 15% in patients with AKI (n = 611, 39%) and without AKI (n = 940), respectively. In patients with AKI, unadjusted, adjusted and propensity-score matched 1-year mortality rates were lower in patients treated with ACEi/ARB at ICU discharge [HR of 0.55 (0.35-0.89), HR of 0.45 (0.27-0.75), and HR of 0.48 (0.27-0.85, p < 0.001), respectively]. These results were consistent across sensitivity analysis. No association was observed in patients without AKI.

Conclusions: In patients discharged alive from the ICU after experiencing AKI, ACEi/ARB prescription at discharge is associated with a decrease in 1-year mortality.

Trial registration: ClinicalTrials.gov NCT01367093. Registered on 6 June 2011.

Keywords: Acute kidney injury; Angiotensin-converting enzyme inhibitors; Angiotensin-receptor blockers; Critically Ill; ICU; ICU discharge; Mortality.

References

    1. Crit Care Med. 2015 Feb;43(2):354-64
    1. Intensive Care Med. 2015 Aug;41(8):1411-23
    1. Intensive Care Med. 2017 Jun;43(6):855-866
    1. Circulation. 2010 Aug 17;122(7):717-28, 18 p following 728
    1. Nephron. 2017;137(4):273-276
    1. Stat Med. 1996 Feb 28;15(4):361-87
    1. BMC Anesthesiol. 2015 Oct 12;15:143
    1. Crit Care. 2018 Jan 18;22(1):8
    1. Sci Rep. 2017 Apr 13;7:46518
    1. Kidney Int. 2018 Feb;93(2):460-469
    1. Nephrol Dial Transplant. 2012 Jan;27(1):136-45
    1. N Engl J Med. 2014 Jul 3;371(1):58-66
    1. Exp Physiol. 2008 May;93(5):622-30
    1. Pharmacol Res. 2016 May;107:154-162
    1. J Am Coll Cardiol. 2016 Apr 12;67(14):1687-97
    1. Nephrol Dial Transplant. 2015 Jun;30(6):978-88
    1. JAMA. 2018 Jan 2;319(1):62-75
    1. BMC Nephrol. 2017 Jan 6;18(1):9
    1. Am J Physiol Renal Physiol. 2015 Dec 1;309(11):F943-54
    1. Sci Rep. 2016 Sep 28;6:34265
    1. Intensive Care Med. 2017 Jun;43(6):730-749
    1. Hypertension. 2018 Jun;71(6):e13-e115
    1. Exp Physiol. 2012 Apr;97(4):477-85

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere