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. 2024 May 1:15:1343647.
doi: 10.3389/fphar.2024.1343647. eCollection 2024.

Pre-operative maintenance of angiotensin-converting enzyme inhibitors is not associated with acute kidney injury in cardiac surgery patients with cardio-pulmonary bypass: a propensity-matched multicentric analysis

Pierre Guilleminot  1 , Stefan Andrei  2 , Maxime Nguyen  3   4 , Osama Abou-Arab  5 , Emmanuel Besnier  6 , Belaid Bouhemad  3   4 , Pierre-Grégoire Guinot  3   4 ; Collaborator study group
Collaborators, Affiliations

Pre-operative maintenance of angiotensin-converting enzyme inhibitors is not associated with acute kidney injury in cardiac surgery patients with cardio-pulmonary bypass: a propensity-matched multicentric analysis

Pierre Guilleminot et al. Front Pharmacol. .

Abstract

Objective: We investigated the effects of the maintenance of angiotensin-converting enzyme inhibitors (ACE inhibitors) the day of the surgery on the incidence of postoperative acute kidney injury (AKI) and cardiac events in patients undergoing cardiac surgery. Methods: We performed a multicentric observational study with propensity matching on 1,072 patients treated with ACE inhibitors. We collected their baseline demographic data, comorbidities, and operative and postoperative outcomes. AKI was defined by KDIGO (Kidney Disease: Improving Global Outcome). Results: Maintenance of an ACE inhibitor was not associated with an increased risk of AKI (OR: 1.215 (CI95%:0.657-2.24), p = 0.843, 71 patients (25.1%) vs. 68 patients (24%)). Multivariate logistic regression and sensitive analysis did not demonstrate any association between ACE inhibitor maintenance and AKI, following cardiac surgery (OR: 1.03 (CI95%:0.81-1.3)). No statistically significant difference occurs in terms of incidence of cardiogenic shock (OR: 1.315 (CI95%:0.620-2.786)), stroke (OR: 3.313 (CI95%:0.356-27.523)), vasoplegia (OR: 0.741 (CI95%:0.419-1.319)), postoperative atrial fibrillation (OR: 1.710 (CI95%:0.936-3.122)), or mortality (OR: 2.989 (CI95%:0.343-26.034)). ICU and hospital length of stays did not differ (3 [2; 5] vs. 3 [2; 5] days, p = 0.963 and 9.5 [8; 12] vs. 10 [8; 14] days, p = 0.638). Conclusion: Our study revealed that maintenance of ACE inhibitors on the day of the surgery was not associated with increased postoperative AKI. ACE inhibitor maintenance was also not associated with an increased rate of postoperative major cardiovascular events (arterial hypotension, cardiogenic shock, vasopressors use, stroke and death).

Keywords: acute kidney injury; angiotensin-converting enzyme inhibitors; atrial fibrillation; cardiac surgery; cardio-pulmonary bypass.

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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. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.

Figures

FIGURE 1
FIGURE 1
Study flowchart.
FIGURE 2
FIGURE 2
Incidence of postoperative acute kidney injury, death, cardiogenic shock, stroke, and vasopressor use according to angiotensin-converting enzyme (ACE) inhibitor maintenance or withholding.
FIGURE 3
FIGURE 3
Forrest plot of factors associated with angiotensin-converting enzyme (AKI). The odds ratio and their 95% confidence interval are presented in the figure. Variables in bold have a significant association (p < 0.05).
See this image and copyright information in PMC

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References

    1. Antoniak D. T., Walters R. W., Alla V.M. (2021). Impact of Renin-Angiotensin System Blockers on Mortality in Veterans Undergoing Cardiac Surgery. J. Am. Heart Assoc. 10 (10), e019731. 10.1161/JAHA.120.019731 - DOI - PMC - PubMed
    1. Bandeali S. J., Kayani W. T., Lee V.-V., Pan W., Elayda M. A. A., Nambi V., et al. (2012). Outcomes of preoperative angiotensin-converting enzyme inhibitor therapy in patients undergoing isolated coronary artery bypass grafting. Am. J. Cardiol. 110, 919–923. 10.1016/j.amjcard.2012.05.021 - DOI - PubMed
    1. Benedetto U, Sciarretta S, Roscitano A, Fiorani B, Refice S, Angeloni E, Sinatra R., et al. (2008). Preoperative Angiotensin-converting enzyme inhibitors and acute kidney injury after coronary artery bypass grafting. Ann Thorac Surg. 86(4):1160–1165. 10.1016/j.athoracsur.2008.06.018 - DOI - PubMed
    1. Brown J. K., Shaw A. D., Mythen M. G., Guzzi L., Reddy V. S., Crisafi C., et al. (2023). Adult cardiac surgery-associated acute kidney injury: joint consensus report. J. Cardiothorac. Vasc. Anesth. 37, 1579–1590. 10.1053/j.jvca.2023.05.032 - DOI - PubMed
    1. Campbell N. G., Wollborn J., Fields K. G., Lip G. Y. H., Ruetzler K., Muehlschlegel J. D., et al. (2022). Inconsistent methodology as a barrier to meaningful research outputs from studies of atrial fibrillation after cardiac surgery. J. Cardiothorac. Vasc. Anesth. 36, 739–745. 10.1053/j.jvca.2021.10.009 - DOI - PMC - PubMed