TY - JOUR
T1 - Prospective cohort study of renin-angiotensin system blocker usage after hospitalized acute kidney injury
AU - Assessment Serial Evaluation Subsequent Sequelae in Acute Kidney Injury (ASSESS-AKI) study investigators
AU - Brar, Sandeep
AU - Liu, Kathleen D.
AU - Go, Alan S.
AU - Hsu, Raymond K.
AU - Chinchilli, Vernon M.
AU - Coca, Steven G.
AU - Garg, Amit X.
AU - Himmelfarb, Jonathan
AU - Ikizler, T. Alp
AU - Kaufman, James
AU - Kimmel, Paul L.
AU - Parikh, Chirag R.
AU - Siew, Edward D.
AU - Ware, Lorraine B.
AU - Zeng, Hui
AU - Hsu, Chi Yuan
N1 - Funding Information:
V. Chinchilli reports serving as a scientific advisor or member of AstraZeneca, Jannsen, Regeneron, and Sanofi. S. Coca reports consultancy agreements with Akebia, Bayer, Boehringer Ingelheim, CHF Solutions, Quark, Relypsa, RenalytixAI, and Takeda; serving on the editorial boards for CJASN, JASN, and Kidney International, andasanassociateeditorforKidney360;employmentatIcahnSchool of Medicine at Mount Sinai, which owns part of RenalytixAI; receiving research funding from inRegen and RenalytixAI; ownership interest in pulseData and RenalytixAI; patents and inventions with RenalytixAI; and serving as a scientific advisor or member of Re-nalytixAI. A. Garg reports serving on the editorial boards of AmericanJournalofKidneyDiseasesandKidneyInternational;receiving research funding from Astellas; serving on the data safety and monitoring board for an investigator-initiated trial program funded by GlaxoSmithKline; employment at London Health Sciences Centre; and serving a medical lead role to improve access to kidney transplantation and living kidney donation for the Ontario Renal Network (government-funded agency located within Ontario Health). A. Go reports receiving research funding from Amarin, CSL Behring, and Novartis, and employment at Kaiser Permanente Northern California. J. Himmelfarb reports having consultancy agreements with Akebia Therapeutics, Chinook Therapeutics, Maze Therapeutics, Pfizer, RenalytixAI, and Seattle Genetics; serving as founder, president, and board member of AKTIV-X Technologies, Inc.; receiving honoraria from various academic institutions for invited lectures; serving on the editorial boards for BMC Medicine and CJASN, and serving on the scientific advisory board for Nature Reviews Nephrology; and receiving research grant support from Northwest Kidney Centers. C. Hsu reports receiving consulting fees from EcoR1 Capital Fund; consulting fees from Health Advances; legal consulting fees from Ice Miller LLP; grants from National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), during the conduct of the study; and consulting fees from Reata; grants from Satellite Healthcare; royalties from UpToDate; serving on the editorial board for JASN; and serving on the scientific advisory board and being a speaker at the medical directors meeting from Satellite Healthcare; outside the submitted work. R. Hsu reports serving as a scientific advisor or member of Retrophin. T. Ikizler reports having consultancy agreements with Abbott Renal Care, Corvidia, Fresenius Kabi, ISN, and Nestle; receiving honoraria from Abbott Renal Care, Fresenius Kabi, ISN, and Nestle; serving as a scientific advisor or member of Fresenius Kabi and Kidney International; and patents and inventions from Vanderbilt University Medical Center. J. Kaufman reports serving as associate editor for American Journal of Kidney Disease and being the steering committee chair of ASSESS-AKI, NIDDK; ownership interest in Amgen; and having consultancy agreements with the National Institutes of Health and National Kidney Foundation. P. Kimmel is the coeditor of Chronic Renal Disease (Second Edition, San Diego, CA, Academic Press, 2020) and coeditor of Psychosocial Aspects of Chronic Renal Disease (San Diego, CA, Academic Press, 2021). K. Liu reports receiving honoraria from the American Society ofNephrology; servingon theeditorialboardsfor AmericanJournal of Kidney Diseases, American Journal of Respiratory and Critical Care Medicine, and CJASN; holding stock in Amgen; and having consultancy agreements with Astute and Potrero Medical. C. Parikh reports having consultancy agreements with Genfit Biopharmaceutical Company; receiving research funding from the National Heart Lung and Blood Institute and NIDDK; serving as a scientific advisor or member of Genfit Biopharmaceutical Company and Renalytix; and having ownership interest in Renaltix AI. E. Siew reports receiving consultancy agreements with Akebia Therapeutics (April 2019); serving as an associate editor for CJASN; receiving honorarium for an educational talk provided at DaVita Annual Physician Conference (March 2019); employment at Nashville Veterans Affairs; and receiving author royalties from UpToDate. L. Ware reports receiving consultancy agreements with Bayer, Boehringer Ingelheim, Citius, CSL Behring, Foresee, Merck, and Quark; receiving research funding from Boehringer Ingelheim, CSL Behring, Genentech, and Global Blood Therapeutics; and serving as a scientific advisor or member of Boehringer Ingelheim and Citius. All remaining authors have nothing to disclose.
Funding Information:
ASSESS-AKI was supported by cooperative agreements from the NIDDK, grants U01DK082223, U01DK082185, U01DK082192, and U01DK082183. We also acknowledge funding support from NIDDK grants R01DK098233, R01DK101507, R01DK114014, R03DK111881, K24DK92291, and K24DK113381.
Publisher Copyright:
© 2021 by the American Society of Nephrology.
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/1
Y1 - 2021/1
N2 - Background and objectives The risk-benefit ratio of angiotensin-converting enzyme inhibitor or angiotensin receptor blocker therapy after AKI may be altered due to concerns regarding recurrent AKI. We evaluated, in a prospective cohort, the association between use (versus nonuse) of angiotensin-converting enzyme inhibitors/ angiotensin receptor blockers and the subsequent risk of AKI and other adverse outcomes after hospitalizations with and without AKI. Design, setting, participants, & measurements We studied 1538 patients recently discharged from the hospital who enrolled in the multicenter, prospective ASSESS-AKI study, with approximately half of patients experiencing AKI during the index hospitalization. All participants were seen at a baseline visit 3 months after their index hospitalization and were categorized at that time on whether they were using angiotensin-converting enzyme inhibitors/angiotensin receptor blockers or not. We used multivariable Cox regression, adjusting for de-mographics, comorbidities, eGFR, urine protein-creatinine ratio, and use of other medications, to examine the association between angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use and subsequent risks of AKI, death, kidney disease progression, and adjudicated heart-failure events. Results The use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers was 50% (386/769) among those with AKI during the index hospitalization and 47% (362/769) among those without. Among those with AKI during the index hospitalization, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use was not associated with a higher risk of recurrent hospitalized AKI (adjusted hazard ratio, 0.88; 95% confidence interval, 0.69 to 1.13). Associations between angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use and death, kidney disease progression, and adjudicated heart-failure events appeared similar in study participants who did and did not experience AKI during the index hospitalization (all interaction P values >0.05). Conclusions The risk-benefit ratio of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker therapy after hospital discharge appears to be similar regardless of whether AKI occurred during the hospitalization.
AB - Background and objectives The risk-benefit ratio of angiotensin-converting enzyme inhibitor or angiotensin receptor blocker therapy after AKI may be altered due to concerns regarding recurrent AKI. We evaluated, in a prospective cohort, the association between use (versus nonuse) of angiotensin-converting enzyme inhibitors/ angiotensin receptor blockers and the subsequent risk of AKI and other adverse outcomes after hospitalizations with and without AKI. Design, setting, participants, & measurements We studied 1538 patients recently discharged from the hospital who enrolled in the multicenter, prospective ASSESS-AKI study, with approximately half of patients experiencing AKI during the index hospitalization. All participants were seen at a baseline visit 3 months after their index hospitalization and were categorized at that time on whether they were using angiotensin-converting enzyme inhibitors/angiotensin receptor blockers or not. We used multivariable Cox regression, adjusting for de-mographics, comorbidities, eGFR, urine protein-creatinine ratio, and use of other medications, to examine the association between angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use and subsequent risks of AKI, death, kidney disease progression, and adjudicated heart-failure events. Results The use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers was 50% (386/769) among those with AKI during the index hospitalization and 47% (362/769) among those without. Among those with AKI during the index hospitalization, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use was not associated with a higher risk of recurrent hospitalized AKI (adjusted hazard ratio, 0.88; 95% confidence interval, 0.69 to 1.13). Associations between angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use and death, kidney disease progression, and adjudicated heart-failure events appeared similar in study participants who did and did not experience AKI during the index hospitalization (all interaction P values >0.05). Conclusions The risk-benefit ratio of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker therapy after hospital discharge appears to be similar regardless of whether AKI occurred during the hospitalization.
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U2 - 10.2215/CJN.10840720
DO - 10.2215/CJN.10840720
M3 - Article
C2 - 33272913
AN - SCOPUS:85099544613
VL - 16
SP - 26
EP - 36
JO - Clinical journal of the American Society of Nephrology : CJASN
JF - Clinical journal of the American Society of Nephrology : CJASN
SN - 1555-9041
IS - 1
ER -