AUTHOR=Wu Vin-Cent , Lin Yu-Feng , Teng Nai-Chi , Yang Shao-Yu , Chou Nai-Kuan , Tsao Chun-Hao , Chen Yung-Ming , Chueh Jeff S , Chen Likwang 

TITLE=Angiotensin II Receptor Blocker Associated With Less Outcome Risk in Patients With Acute Kidney Disease

JOURNAL=Frontiers in Pharmacology

VOLUME=13

YEAR=2022

URL=https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2022.714658

DOI=10.3389/fphar.2022.714658

ISSN=1663-9812

ABSTRACT=<p><bold>Objective:</bold> The aim of this study was to explore the respective use of angiotensin-converting-enzyme inhibitors (ACEis) or angiotensin receptor blockers (ARBs) on the outcomes of patients who could be weaned from dialysis-requiring acute kidney injury (AKI-D).</p><p><bold>Methods:</bold> This case–control study enrolled 41,731 patients who were weaned from AKI-D for at least 7 days from Taiwan’s National Health Insurance Administration. We further grouped AKI-D patients according to ACEi and ARB use to evaluate subsequent risks of all-cause mortality and re-dialysis. The outcomes included the all-cause mortality and new-onset of end-stage kidney disease (ESKD; re-dialysis) following withdraw from AKI-D.</p><p><bold>Results:</bold> A total of 17,141 (41.1%) patients surviving AKI-D could be weaned from dialysis for at least 7 days. The overall events of mortality were 366 (48.9%) in ACEi users, 659 (52.1%) in ARB users, and 6,261 (41.3%) in ACEi/ARB nonusers, during a mean follow-up period of 1.01 years after weaning from AKI-D. In regard to all-cause of mortality, pre-dialysis ARB users had lower incidence than ACEi users [hazard ratio (HR 0.82), <italic>p</italic> = 0.017]. Compared with ACEi/ARB nonusers, continuing ARB users had a significantly low risk of long-term all-cause mortality (adjusted hazard ratio 0.51, <italic>p</italic> = 0.013) after propensity score matching. However, new users of ACEi at the acute kidney disease (AKD) period had a higher risk of re-dialysis after weaning than ACEi/ARB nonusers (aHR 1.82, <italic>p</italic> &lt; 0.001), whereas neither ACEi nor ARB users confronted significantly increased risks of hyperkalemia after weaning.</p><p><bold>Conclusions:</bold> Compared with patients without ACEi/ARB, those continuing to use ARB before the event and after weaning had low all-cause mortality, while new users of ACEi at AKD had increased risk of re-dialysis. AKI-D patients continuing to use ACEi or ARB did not have higher risk of hyperkalemia. Future prospective randomized trials are expected to confirm these findings.</p>