scholarly journals Monitoring the Effectiveness and Safety of ARNI vs. Angiotensin Receptor Blocker by Frailty Status

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 209-209
Author(s):  
Elisabetta Patorno ◽  
Chandrasekar Gopalakrishnan ◽  
Dae Kim
Keyword(s):  
Angiotensin Receptor Blockers ◽  
Kidney Injury ◽  
Emergency Department Visits ◽  
Angiotensin Receptor ◽  
Rate Difference ◽  
Frailty Status ◽  
Frail Patients ◽  
Safety Endpoint ◽  
Receptor Blockers ◽  
Effectiveness Endpoint

Abstract Using Medicare data 2015-2017, we conducted 5 sequential 1-to-1 propensity score-matched analyses of ARNI initiators and angiotensin receptor blockers (ARB) initiators, mimicking the accrual of new data every 6 months. Primary effectiveness endpoint was a composite of heart failure hospitalization or all-cause mortality and primary safety endpoint was a composite of hospitalization or emergency department visits for hypotension, acute kidney injury, hyperkalemia, and angioedema. Among non-frail patients (n=5,014), the rates (per 100 person-years) for ARNI vs ARB were 12.7 and 9.2 (rate difference: 3.4, 95% CI: 0.8 to 6.1), respectively, for the effectiveness endpoint and 5.2 and 3.6 (rate difference: 1.5, 95% CI: -0.1 to 3.2), respectively, for the safety endpoint. Among frail patients (n=2,694), the corresponding rates were 19.8 and 21.6 (rate difference: -1.8, 95% CI: -7.0 to 3.4) for the effectiveness endpoint and 10.9 and 8.0 (rate difference: 2.9, 95% CI: -0.6 to 6.4) for the safety endpoint.

scholarly journals Effect of a Perioperative Hypotension-Avoidance Strategy Versus a Hypertension-Avoidance Strategy on the Risk of Acute Kidney Injury: A Clinical Research Protocol for a Substudy of the POISE-3 Randomized Clinical Trial

2022 ◽  
Vol 9 ◽  
pp. 205435812110692
Author(s):  
Amit X. Garg ◽  
Meaghan Cuerden ◽  
Hector Aguado ◽  
Mohammed Amir ◽  
Emilie P. Belley-Cote ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Angiotensin Receptor Blockers ◽  
Kidney Injury ◽  
Angiotensin Receptor ◽  
Primary Analysis ◽  
Antihypertensive Medications ◽  
Renin Inhibitors ◽  
Strategy Versus ◽  
Receptor Blockers ◽  
Avoidance Strategy

Background: Most patients who take antihypertensive medications continue taking them on the morning of surgery and during the perioperative period. However, growing evidence suggests this practice may contribute to perioperative hypotension and a higher risk of complications. This protocol describes an acute kidney injury substudy of the Perioperative Ischemic Evaluation-3 (POISE-3) trial, which is testing the effect of a perioperative hypotension-avoidance strategy versus a hypertension-avoidance strategy in patients undergoing noncardiac surgery. Objective: To conduct a substudy of POISE-3 to determine whether a perioperative hypotension-avoidance strategy reduces the risk of acute kidney injury compared with a hypertension-avoidance strategy. Design: Randomized clinical trial with 1:1 randomization to the intervention (a perioperative hypotension-avoidance strategy) or control (a hypertension-avoidance strategy). Intervention: If the presurgery systolic blood pressure (SBP) is <130 mmHg, all antihypertensive medications are withheld on the morning of surgery. If the SBP is ≥130 mmHg, some medications (but not angiotensin receptor blockers [ACEIs], angiotensin receptor blockers [ARBs], or renin inhibitors) may be continued in a stepwise manner. During surgery, the patients’ mean arterial pressure (MAP) is maintained at ≥80 mmHg. During the first 48 hours after surgery, some antihypertensive medications (but not ACEIs, ARBs, or renin inhibitors) may be restarted in a stepwise manner if the SBP is ≥130 mmHg. Control: Patients receive their usual antihypertensive medications before and after surgery. The patients’ MAP is maintained at ≥60 mmHg from anesthetic induction until the end of surgery. Setting: Recruitment from 108 centers in 22 countries from 2018 to 2021. Patients: Patients (~6800) aged ≥45 years having noncardiac surgery who have or are at risk of atherosclerotic disease and who routinely take antihypertensive medications. Measurements: The primary outcome of the substudy is postoperative acute kidney injury, defined as an increase in serum creatinine concentration of either ≥26.5 μmol/L (≥0.3 mg/dL) within 48 hours of randomization or ≥50% within 7 days of randomization. Methods: The primary analysis (intention-to-treat) will examine the relative risk and 95% confidence interval of acute kidney injury in the intervention versus control group. We will repeat the primary analysis using alternative definitions of acute kidney injury and examine effect modification by preexisting chronic kidney disease, defined as a prerandomization estimated glomerular filtration rate <60 mL/min/1.73 m2. Results: Substudy results will be analyzed in 2022. Limitations: It is not possible to mask patients or providers to the intervention; however, objective measures will be used to assess acute kidney injury. Conclusions: This substudy will provide generalizable estimates of the effect of a perioperative hypotension-avoidance strategy on the risk of acute kidney injury.

scholarly journals Acute Kidney Injury in a Case Series of Patients with Confirmed COVID-19 (Coronavirus Disease 2019): Role of Angiotensin-Converting Enzyme 2 and Renin-Angiotensin System Blockade

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Avantika Chenna ◽  
Venu Madhav Konala ◽  
Subhasish Bose ◽  
Sasmit Roy ◽  
Bhaskar Reddy Madhira ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Angiotensin Converting Enzyme ◽  
Angiotensin Receptor Blockers ◽  
Kidney Injury ◽  
Renin Angiotensin System ◽  
Converting Enzyme ◽  
Angiotensin Receptor ◽  
Angiotensin System ◽  
Renin Angiotensin ◽  
Receptor Blockers

The renin-angiotensin system plays a very critical role in hypertension, diabetes, and kidney and heart diseases. The blockade of the renin-angiotensin system results in the prevention of progression of renal and cardiac damage. There have been controversial hypotheses raised regarding the safety of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in COVID-19 (coronavirus disease 2019). We present the case series of four patients (2 men and 2 women; 1 Caucasian and 3 African Americans; two survived and two died) with confirmed COVID-19, presenting with respiratory symptoms and acute kidney injury, who have been on angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. Membrane-bound angiotensin-converting enzyme 2 (ACE2) has been implicated as the gateway for viral entry into the human cell in causing the infection. The factors contributing to acute kidney injury are diuretics, iodinated contrast administration, hemodynamic instability apart from ACE inhibitors, and angiotensin receptor blockers. The ACE inhibitors and ARBs were stopped in these patients due to acute kidney injury. We also discussed the role of ACE2 and the renin-angiotensin system (RAS) blockade in patients with COVID-19 infection along with pathogenesis.

scholarly journals Impact of Angiotensin-Converting Enzyme Inhibitors or Angiotensin Receptor Blockers on Acute Kidney Injury in Emergency Medical Admissions

2021 ◽  
Vol 10 (3) ◽  
pp. 412
Author(s):  
Athanasios Feidakis ◽  
Maria-Rosa Panagiotou ◽  
Emmanouil Tsoukakis ◽  
Dimitra Bacharaki ◽  
Paraskevi Gounari ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Enzyme Inhibitors ◽  
Angiotensin Receptor Blockers ◽  
Kidney Injury ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Converting Enzyme ◽  
Angiotensin Receptor ◽  
Converting Enzyme Inhibitors ◽  
Emergency Medical ◽  
Receptor Blockers

Background: Acute kidney injury (AKI) has been observed in up to 20% of adult hospital admissions. Sepsis, diarrhea and heart failure, all causing reduced effective volume, are considered risk factors for AKI, especially among patients treated with medications that block the Renin-Angiotensin System (RAS), such as angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB). We aimed to determine the incidence of acute kidney injury (AKI) in emergency medical admissions in relation to the use and dosage of ACEi/ARB. Methods: A single-center observational study conducted in 577 consecutive medical admissions via the Emergency Room (ER) at a University General Hospital in Athens, Greece, between June and July 2018. Patients with incomplete medical records, discharged within 24 h, maintained on chronic renal replacement therapy, admitted to the Cardiology Department or the ICU were excluded. Thus, a total of 309 patients were finally included in this analysis. Results: We compared 86 (28%) patients who presented in the ER with AKI (AKIGroup) with 223 (72%) patients without AKI (non-AKI Group) at the time of admission. Patients in the AKI Group were more frequently male (58% vs. 46%, p = 0.06), with a higher frequency of diarrhea (16% vs. 6%, p = 0.006), edema (15% vs. 6%, p = 0.014) and lower systolic blood pressure (120 (107–135) vs. 126 (113–140), p = 0.007) at presentation, despite higher prevalence of hypertension (64% vs. 47%, p = 0.006). Overall, ACEi/ARB were more likely to have been prescribed in the AKI Group than in the non-AKI Group (49% vs. 28%, p = 0.001). Interestingly, AKI was more frequently observed in patients treated with the target or above target dosage of ACEi/ARB, but not in those receiving lower than the recommended dosage. Conclusion: The risk of AKI in emergency medical admissions is higher among users of ACEIs/ARB at target or above target dosages. Physicians should adjust RAS blockade according to estimated Glomerular Filtration Rate (eGFR) and advise their patients to withhold ACEi/ARB in cases of acute illness.

Abstract 19094: Use of ACE Inhibitors or Angiotensin Receptor Blockers is Associated With a Significantly Lower Risk of 30-day All-cause and Heart Failure Readmissions and All-cause Mortality in Older Medicare Beneficiaries Hospitalized for Heart Failure Developing Acute Kidney Injury

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Mohammed Siddiqui ◽  
Paul W Sanders ◽  
Garima Arora ◽  
Charity Morgan ◽  
Sijian Zhang ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Kidney Injury ◽  
Serum Creatinine ◽  
Angiotensin Receptor Blockers ◽  
Kidney Injury ◽  
Angiotensin Receptor ◽  
Medicare Beneficiaries ◽  
All Cause Mortality ◽  
Receptor Blockers ◽  
Discharge Prescription

Background: We presented data that demonstrating that acute kidney injury (AKI) as defined by a rise in admission serum creatinine by ≥0.3mg/dL is associated with a 16% significant increase in 30-day all-cause readmission in hospitalized heart failure (HF) patients (Circulation. 2014; 130: A19999). We have previously published data suggesting that the use of angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) is associated with improved outcomes in HF patients with chronic kidney disease (PMC3324926 and PMC3575519). However, these drugs are often avoided in HF patients with AKI. Methods: Of the 8049 Medicare beneficiaries hospitalized for HF and discharged alive from 106 U.S. hospitals (1998-2001), 6854 had data on admission, discharge, and highest serum creatinine, of which 2180 had AKI (a rise in admission serum creatinine by ≥0.3 mg/dL) and of these 1171 (54%) received a discharge prescription for ACEIs or ARBs. Using propensity scores for ACEI or ARB use, we assembled a matched cohort of 755 pairs of patients balanced on 33 baseline characteristics including baseline serum creatinine and rise of serum creatinine. Results: 30-day all-cause readmission occurred in 21% and 27% of matched patients receiving and not receiving ACEIs or ARBs, respectively (HR, 0.77; 95% CI, 0.62-0.95; p=0.015). 30-day HF readmission occurred in 6% and 11% of matched patients receiving and not receiving ACEIs or ARBs, respectively (HR, 0.53; 95% CI, 0.37-0.76; p=0.001). 30-day all-cause mortality occurred in 5% and 9% of matched patients receiving and not receiving ACEIs or ARBs, respectively (HR, 0.89; 95% CI, 0.79-1.00; p=0.052). Both readmission and mortality benefits persisted for 12 months post-discharge (Figure). Conclusions: Among patients hospitalized for HF who developed AKI after hospital admission, discharge prescription of ACEIs or ARBs was associated with significant short- and long-term improvements in outcomes.

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