Abstract
BackgroundThe risk of acute kidney injury (AKI) attributable to renin angiotensin aldosterone (RAAS) inhibitors and diuretics remains unclear.MethodsWe conducted a prospective cohort study using the Clinical Practice Research Datalink (2008–2015) linked to Hospital Episode Statistics – Admitted Patient Care and Office for National Statistics mortality data. Patients were included if they had one or more chronic diagnoses requiring medication. Exposed patients had a first ever prescription for RAAS inhibitors/diuretics during the study period. AKI risk associated with exposure was determined by multivariable Cox regression, propensity score-adjusted Cox regression and a prior event rate ratio (PERR) analysis.ResultsOne hundred forty thousand nine hundred fifty-two individuals were included. Increased AKI risk in the exposed group was demonstrated in both the multivariable and propensity score-adjusted cox regressions (HR 1.23 (95% CI 1.04–1.45) and HR 1.24 (1.05–1.47) respectively). The PERR analysis provided a similar overall hazard ratio with a wider confidence interval (HR 1.29 (0.94–1.63)). The increased AKI risk in the exposed group was present only in those receiving two or more antihypertensives. Absolute AKI risk was small.ConclusionsRAAS inhibitors/diuretics result in an increased risk of AKI. The absolute increase in AKI risk is small, however, and needs to be considered in the context of any potential benefits.
Highlights
The risk of acute kidney injury (AKI) attributable to renin angiotensin aldosterone (RAAS) inhibitors and diuretics remains unclear
A meta-analysis of adverse outcomes following AKI conducted in 2009 [6] found the risks of chronic kidney disease (CKD) and end-stage kidney disease (ESKD) following a single episode of AKI to be 7.8 and 4.9/100 patient-years, respectively
Primary care data from Clinical Practice Research Datalink (CPRD) GOLD were linked to the Hospital Episode Statistics – Admitted Patient Care (HES-APC) database, Office for National Statistics Mortality data, and Indices of Multiple Deprivation, as long as patients were eligible for linkage
Summary
The risk of acute kidney injury (AKI) attributable to renin angiotensin aldosterone (RAAS) inhibitors and diuretics remains unclear. The reported incidence of acute kidney injury (AKI) in community-dwelling adults and hospital inpatients varies significantly depending on the criteria used [1]. A recent meta-analysis concluded that worldwide, one in five adults and one in three children experience an episode of AKI during an inpatient admission [2]. There is significant morbidity, mortality and economic cost associated with AKI. A meta-analysis of adverse outcomes following AKI conducted in 2009 [6] found the risks of chronic kidney disease (CKD) and end-stage kidney disease (ESKD) following a single episode of AKI to be 7.8 and 4.9/100 patient-years, respectively. Even mild AKI (a rise in serum creatinine of less than or equal to 25%) was associated with a 70% increase in mortality.
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