Angiotensin-converting enzyme inhibitor usage and acute kidney injury: A secondary analysis of RENAL study outcomes

Amanda Y. Wang, Rinaldo Bellomo, Toshiharu Ninomiya, Serigne Lo, Alan Cass, Meg Jardine, Martin Gallagher, for the RENAL Study Investigators and the ANZICS Clinical Trials Group

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13 Citations (Scopus)

Abstract

Aim: Acute kidney injury (AKI) is associated with increased mortality. While angiotensin-converting enzyme inhibitors (ACEI) are known to slow progression of chronic kidney disease, their role in AKI remains unclear. Methods: The Randomised Evaluation of Normal vs. Augmented Level Replacement Therapy (RENAL) study data were analysed according to ACEI use over time. The primary outcome was all-cause mortality at 90 days following randomisation. Analyses used a multivariate Cox model adjusted for either baseline or for time-dependent covariates, and a sensitivity analysis of patients surviving to at least the median time to ACEI initiation. Results: Of the 1463 participants with available data on ACE inhibitors usage, 142 (9.7%) received ACEI at least once during study data collection. Participants treated with ACEI were older (P = 0.02) and had less sepsis at baseline (P < 0.001). ACEI use was significantly associated with lower mortality at 90 days (HR 0.46, 95% CI 0.30-0.71, P < 0.001), and an increase in renal replacement therapy-free days (P < 0.001), intensive care unit-free days (P < 0.001) and hospital free-days (P < 0.001) after adjusting for baseline covariates. Using the time-dependent analysis, however, the effect of ACEI administration was not significant (HR 0.78, 95% CI 0.51-1.21, P = 0.3). The sensitivity analysis in day 8 survivors produced similar results. Conclusion: In the RENAL study cohort, the use of ACEI during the study was not common and, after adjustment for time-dependent covariates, was not significantly associated with reductions in mortality. Further assessment of the effect of ACEI use in AKI patients is needed.

Original languageEnglish
Pages (from-to)617-622
Number of pages6
JournalNephrology
Volume19
Issue number10
DOIs
Publication statusPublished - Oct 2014
Externally publishedYes

Keywords

  • Acute kidney injury
  • Angiotensin-converting enzyme inhibitor
  • Dialysis
  • Mortality
  • Prospective study

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