Association of ACEIs/ARBs treatment with clinical outcomes in acute kidney injury: a multicenter retrospective cohort analysis

Background

ACEIs/ARBs (angiotensin-converting enzyme inhibitors/angiotensin receptor blockers) constituted the cornerstone of therapy for various cardiovascular and renal disorders. The appropriate management of ACEIs/ARBs in the acute kidney injury (AKI) remained controversial.

Methods

In this multicenter study involving 1,285 AKI patients, we investigated the associations of ACEIs/ARBs discontinuation (n = 436), persistence (n = 657), and initiation (n = 192) with 14-day AKI progression and mortality. Multivariate logistic regression analysis and subgroup analyses were conducted to evaluate the associations between ACEI/ARB utilization patterns and clinical outcomes.

Results

The persistence usage of ACEIs/ARBs was independently associated with lower odds of 14-day AKI progression compared to discontinuation (adjusted OR 0.44, 95% CI 0.29–0.67, P < 0.001) Regarding 14-day mortality, the persistence usage of ACEIs/ARBs exhibited an inverse correlation in the unadjusted model (OR 0.30, 95% CI 0.13–0.71, P = 0.006), but the association was attenuated after full adjustment model (OR 0.39, 95% CI 0.13–1.20, P = 0.101). No statistically significant differences in the risk of 14-day AKI progression or mortality were observed between the initiation and discontinuation cohorts across all models.

Conclusions

In this retrospective cohort, the persistence of ACEI/ARB at the onset of AKI was associated with lower odds of 14-day progression, but not mortality. For the 14-day mortality, due to limited events, wide-ranging confidence intervals, and post-adjustment attenuation, these statistical instabilities need highly conservative interpretation and prospective validation.

Clinical trial number

Not applicable.