Abstract
Background: Renin-angiotensin-aldosterone system (RAAS) blockers are widely used for the treatment of hypertension and heart failure, but the usage of angiotensin- converting enzyme inhibitors (ACEi) or angiotensin-receptor blockers (ARB) demands caution due to a potential risk of causing acute kidney injury (AKI). Whether long-term RAAS blockade increases AKI risk and should be withdrawn during critical illness remains inconclusive. This study aimed to investigate the associations between RAAS blockade strategies and AKI incidence in patients admitted to intensive care units (ICUs). Methods: Twenty-four hundred dialysis-free patients admitted to ICUs during December 2015–July 2017 were enrolled. Patients with pre-ICU AKI (n=568) were excluded when examining in-ICU AKI events. Patients using ACEi or ARB for more than 1 month before hospitalization were defined as long-term ACEi/ARB users. ACEi/ARB users were further grouped by ACEi/ARB continuation/withdrawal at ICU admission. Daily urine output and serum creatinine were measured in ICU. The primary outcome was occurrence of AKI within 48 hours after ICU admission, and the secondary outcome was all-cause mortality within 1 year. Results: Totally 1181 (49.2%) AKI cases and 895 (37.3%) deaths within 1 year occurred. ACEis/ARBs were continued for 122 patients and withdrawn for 239 patients. ACEi/ARB users were older and had lower initial estimated glomerular filtration rates (eGFRs). Compared with non-use, long-term ACEi/ARB use [odds ratio (OR) 1.03, 95% confidence interval (CI) 0.85–1.26, p=0.741] and continued ICU use (OR 1.14, 95% CI 0.78–1.68, p=0.491) were not associated with increased AKI risk. ACEi/ARB use was associated with less 1-year mortality. However, compared with withdrawal, continued ACEi/ARB use in ICUs was associated with higher AKI incidence among patients with sepsis (OR 2.89, 95% CI 1.35–6.20, p=0.006). Conclusions: Long-term RAAS blockade was not associated with a higher AKI or mortality incidence during acute illness. Continued ACEi/ARB use in ICUs may increase AKI risk in septic patients. Long-term and continued ACEi/ARB use are recommended, with cautious evaluation at ICU admission.
Associations Between Intravenous (IV) Contrast, Renin Angiotensin Aldosterone System Blockade (RAASB), and Diuretics and Acute Kidney Injury (AKI) and Mortality in Hospitalized Patients
