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      Use of Angiotensin-Converting Enzyme Inhibitors/Angiotensin Receptor Blockers and Acute Kidney Disease after an Episode of AKI: A Multicenter Prospective Cohort Study


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          Background: Persistence of acute kidney disease (AKD) after an episode of acute kidney injury (AKI) is associated with adverse outcomes. Multiple factors contribute to AKD after AKI, but the role of angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (ACEI/ARB) remains controversial. We examined if acute exposure to an ACEI/ARB associates with persistent AKD in survivors of AKI. Methods: Multicenter prospective cohort study of patients whose hospitalization was complicated by AKI and who attended specialized AKI follow-up clinics between 2013 and 2018. Acute exposure was defined as ACEI/ARB exposure for ≥48 h before or during the AKI episode. The primary outcome was AKD (serum creatinine ≥1.5 times above pre-AKI baseline) at the first clinic visit. We used multivariable logistic regression to adjust for potential confounders. Results: We included 345 survivors of AKI, 112 with persistent AKD at the first outpatient visit. Among 163 patients who were prescribed an ACEI/ARB before hospitalization, only 23% were discharged on an ACEI/ARB. There was no difference in the rate of AKD in patients discharged versus not discharged on an ACEI/ARB (12.5 vs. 15.0%, p = 0.530). Of the patients with AKD, 22 (19.6%) patients had acute ACEI/ARB exposure during the hospitalization. In fully adjusted models, acute exposure to an ACEI/ARB was not associated with AKD at the time of first clinic visit (median [interquartile range] 33 [18–54] days from hospital discharge). Conclusion: Acute exposure to an ACEI/ARB before or during an episode of AKI was not associated with persistent AKD at the time of first clinic visit suggesting that the receipt of such agents does not impede kidney recovery following AKI. Contrary to prevailing recommendations and current practice, the continued administration of an ACEI/ARB during an episode of AKI or initiation of these agents prior to discharge may be safe.

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          Author and article information

          Am J Nephrol
          American Journal of Nephrology
          S. Karger AG
          April 2020
          21 February 2020
          : 51
          : 4
          : 266-275
          [_a] aDivision of Nephrology, Department of Internal Medicine, Bone and Mineral Metabolism, University of Kentucky, Lexington, Kentucky, USA
          [_b] bDepartment of Pharmacy, University of Kentucky HealthCare, Lexington, Kentucky, USA
          [_c] cCollege of Pharmacy, University of Kentucky, Lexington, Kentucky, USA
          [_d] dDepartment of Population and Data Sciences, University of Texas Southwestern, Dallas, Texas, USA
          [_e] eDivision of Nephrology, Department of Internal Medicine, University of Toronto, Toronto, Ontario, Canada
          [_f] fDivision of Nephrology, Department of Medicine, Queens University, Kingston, Ontario, Canada
          Author notes
          *Javier A. Neyra, MD, MSCS, Division of Nephrology, Department of Internal Medicine, Bone and Mineral Metabolism, University of Kentucky Medical Center, 800 Rose Street, MN668, Lexington, KY 40536 (USA), E-Mail javier.neyra@uky.edu
          505893 Am J Nephrol 2020;51:266–275
          © 2020 S. Karger AG, Basel

          Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

          : 18 October 2019
          : 30 December 2019
          Page count
          Figures: 3, Tables: 3, Pages: 10
          Novel Research Findings

          Cardiovascular Medicine,Nephrology
          Acute kidney injury,Recovery,Angiotensin II receptor blockers,Acute kidney disease,Renin-Angiotensin-Aldosterone System inhibitors,Angiotensin-converting enzyme inhibitors


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