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

• Published in: Intensive care medicine Vol. 44; no. 5; pp. 598 - 605
• Main Authors: Gayat, Etienne, Hollinger, Alexa, Cariou, Alain, Deye, Nicolas, Vieillard-Baron, Antoine, Jaber, Samir, Chousterman, Benjamin G., Lu, Qin, Laterre, Pierre François, Monnet, Xavier, Darmon, Michael, Leone, Marc, Guidet, Bertrand, Sonneville, Romain, Lefrant, Jean-Yves, Fournier, Marie-Céline, Resche-Rigon, Matthieu, Mebazaa, Alexandre, Legrand, Matthieu
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.05.2018; Springer; Springer Nature B.V; Springer Verlag
• Subjects: ACE inhibitors; Analysis; Anesthesiology; Angiotensin; Angiotensin-converting enzyme inhibitors; Blood pressure; Care and treatment; Chronic kidney failure; Clinical outcomes; Comorbidity; Critical Care Medicine; Diabetes; Diabetes mellitus; Discharge; Emergency Medicine; France; Glomerular filtration rate; Heart; Heart diseases; Human health and pathology; Injuries; Intensive; Intensive care; Kidneys; Life Sciences; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Mortality; Pain Medicine; Patient outcomes; Patients; Pediatrics; Peptidyl-dipeptidase A; Pharmaceutical sciences; Pharmacology; Pneumology/Respiratory System; Renin; Sensitivity analysis; Seven-Day Profile Publication; Urology and Nephrology; France; Angiotensin-converting enzyme inhibitors; Acute kidney injury; Mortality; ICU; Critically Ill; Angiotensin-receptor blockers; ICU discharge
• ISSN: 0342-4642; 1432-1238; 1432-1238
• DOI: 10.1007/s00134-018-5160-6

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.