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. 2022 Apr 20:13:714658.
doi: 10.3389/fphar.2022.714658. eCollection 2022.

Angiotensin II Receptor Blocker Associated With Less Outcome Risk in Patients With Acute Kidney Disease

Vin-Cent Wu  1 , Yu-Feng Lin  1 , Nai-Chi Teng  2 , Shao-Yu Yang  1 , Nai-Kuan Chou  3 , Chun-Hao Tsao  3 , Yung-Ming Chen  1 , Jeff S Chueh  4   5 , Likwang Chen  2
Affiliations

Angiotensin II Receptor Blocker Associated With Less Outcome Risk in Patients With Acute Kidney Disease

Vin-Cent Wu et al. Front Pharmacol. .

Abstract

Objective: The aim of this study was to explore the respective use of angiotensin-converting-enzyme inhibitors (ACEis) or angiotensin receptor blockers (ARBs) on the outcomes of patients who could be weaned from dialysis-requiring acute kidney injury (AKI-D). Methods: This case-control study enrolled 41,731 patients who were weaned from AKI-D for at least 7 days from Taiwan's National Health Insurance Administration. We further grouped AKI-D patients according to ACEi and ARB use to evaluate subsequent risks of all-cause mortality and re-dialysis. The outcomes included the all-cause mortality and new-onset of end-stage kidney disease (ESKD; re-dialysis) following withdraw from AKI-D. Results: A total of 17,141 (41.1%) patients surviving AKI-D could be weaned from dialysis for at least 7 days. The overall events of mortality were 366 (48.9%) in ACEi users, 659 (52.1%) in ARB users, and 6,261 (41.3%) in ACEi/ARB nonusers, during a mean follow-up period of 1.01 years after weaning from AKI-D. In regard to all-cause of mortality, pre-dialysis ARB users had lower incidence than ACEi users [hazard ratio (HR 0.82), p = 0.017]. Compared with ACEi/ARB nonusers, continuing ARB users had a significantly low risk of long-term all-cause mortality (adjusted hazard ratio 0.51, p = 0.013) after propensity score matching. However, new users of ACEi at the acute kidney disease (AKD) period had a higher risk of re-dialysis after weaning than ACEi/ARB nonusers (aHR 1.82, p < 0.001), whereas neither ACEi nor ARB users confronted significantly increased risks of hyperkalemia after weaning. Conclusions: Compared with patients without ACEi/ARB, those continuing to use ARB before the event and after weaning had low all-cause mortality, while new users of ACEi at AKD had increased risk of re-dialysis. AKI-D patients continuing to use ACEi or ARB did not have higher risk of hyperkalemia. Future prospective randomized trials are expected to confirm these findings.

Keywords: ACEi; AKD; AKI; ARB; dialysis; hyperkalemia; mortality; weaning.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Flow diagram of the enrollee.
FIGURE 2
FIGURE 2
Cox proportional plots depicting (A) survival probability levels of before-dialysis ARB and ACEi users, as well as nonusers, and (B) survival probability levels of prior ARB, prior ACEi, continuing ARB, continuing ACEi, and new users, as well as nonusers.
FIGURE 3
FIGURE 3
Cox proportional plots depicting (A) end-stage kidney disease (ESKD) risk levels of before-dialysis ARB and ACEi users, as well as nonusers, and (B) ESKD risk levels of prior ARB, prior ACEi, continuing ARB, continuing ACEi, and new users, as well as nonusers, taking mortality as a competing risk after AKI-D.
FIGURE 4
FIGURE 4
Forest plot comparing risk levels of all-cause mortality for before-dialysis ACEi and ARB users.
See this image and copyright information in PMC

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