AUTHOR=Zhu Xu , Xue Jing , Liu Zheng , Dai Wenjie , Xiang Jingsha , Xu Hui , Zhou Qiaoling , Zhou Quan , Wei Xinran , Chen Wenhang 

TITLE=The effects of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers in critically ill patients with acute kidney injury: An observational study using the MIMIC database

JOURNAL=Frontiers in Pharmacology

VOLUME=Volume 13 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2022.918385

DOI=10.3389/fphar.2022.918385

ISSN=1663-9812

ABSTRACT=Background: The safety of prescribing angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) during acute kidney injury (AKI) remains unclear. We aimed to investigate the associations of ACEI/ARB therapy in AKI with the risk of mortality, acute kidney disease (AKD), and hyperkalemia.
Methods: We conducted a retrospective propensity score-matched cohort study, which included patients from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. The association between ACEI/ARB therapy and mortality was assessed using Cox proportional hazards regression models. Logistic regression was used to assess the risk of AKD and hyperkalemia.
Results: Among the 19,074 individuals with AKI admitted to the intensive care unit (ICU), 12,090 (63.4%) received ACEI/ARBs, while 6,984 (36.6%) did not. In the propensity score-matched sample of 10,300 individuals, we found a decreased risk of mortality in those who received ACEI/ARBs compared to those who did not (hazard ratio [HR] for ICU mortality: 0.63, 95% confidence interval [CI]: 0.54–0.73); HR for in-hospital mortality: 0.72, 95% CI: 0.64–0.80; HR for 30-day mortality: 0.73, 95% CI: 0.66–0.81; HR for 180-day mortality: 0.75, 95% CI: 0.67–0.82). However, the use of ACEI/ARBs was associated with a higher risk of AKD (risk ratio [RR]: 2.90; 95% CI: 2.49–3.37). Patients who received ACEI/ARBs in the ICU were also at a greater risk for hyperkalemia compared to those who did not (RR: 1.37; 95% CI: 1.13–1.67).
Conclusions: ACEI/ARB treatment during an episode of AKI may decrease all-cause mortality, but increases the risk of AKD and hyperkalemia. Future randomized controlled trials are warranted to validate these findings.