Risk factors associated with biochemically detected and hospitalised acute kidney injury in patients prescribed renin angiotensin system inhibitors

Patrick B. Mark*, Richard Papworth, Nitish Ramparsad, Laurie Tomlinson, Simon Sawhney, Corri Black, Alex McConnachie, Colin McCowan

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Aims Therapy with angiotensin converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) is a mainstay of treatment for heart failure (HF), diabetes mellitus (DM) and chronic kidney disease (CKD). These agents have been associated with development of acute kidney injury (AKI) during intercurrent illness. Risk factors for AKI in patients prescribed ACEi/ARB therapy are not well described.
Methods We the incidence of AKI in patients commencing ACEi/ARB during 2009‐2015 using anonymised patient records. Hospital‐coded AKI was defined from hospital episode statistics; biochemical AKI was ascertained from laboratory data. Risk factors for biochemically detected and hospitalised AKI were investigated.
Results Of 61,318 patients prescribed ACEi/ARB, with 132,885 person years (py) follow up, there were 1,070 hospitalisations with AKI as a diagnoses recorded and a total of 4,645 AKI events, including AKI episodes indicated by biochemical KDIGO‐based creatinine change criteria. Incidence of any AKI event was 35.0 per 1000‐ py, hospital‐coded AKI was 7.8 per 1000‐py and biochemical AKI was 33.7 per 1000‐py. Independent risk factors in a multivariable model for hospital‐coded AKI events were age, male gender, HF, diabetes, cerebrovascular disease, lower estimated glomerular filtration rate, socioeconomic deprivation, diuretic or non‐steroidal anti‐inflammatory use (all p<0.001).
Conclusion In patients prescribed ACEi/ARB, the highest risk of AKI is associated with conditions which are considered strong evidence‐based indications for their prescription. Socio‐economic status is an under‐reported risk factor for AKI with these agents. Strategies targeted at prevention of AKI may be of benefit, such as enhanced awareness based on higher risk comorbidities.
Original languageEnglish
JournalBritish Journal of Clinical Pharmacology
Early online date3 Jan 2020
DOIs
Publication statusE-pub ahead of print - 3 Jan 2020

Fingerprint

Renin-Angiotensin System
Acute Kidney Injury
Angiotensin Receptor Antagonists
Angiotensin-Converting Enzyme Inhibitors
Heart Failure
Cerebrovascular Disorders
Incidence
Treatment Failure
Glomerular Filtration Rate
Chronic Renal Insufficiency
Diuretics
Social Class
Prescriptions
Comorbidity
Creatinine

Keywords

  • acute kidney injury
  • angiotensin converting enzyme inhibitor
  • angiotensin receptor blocker
  • heart failure
  • chronic kidney disease

Cite this

Risk factors associated with biochemically detected and hospitalised acute kidney injury in patients prescribed renin angiotensin system inhibitors. / Mark, Patrick B.; Papworth, Richard; Ramparsad, Nitish; Tomlinson, Laurie ; Sawhney, Simon; Black, Corri; McConnachie, Alex; McCowan, Colin.

In: British Journal of Clinical Pharmacology, 03.01.2020.

Research output: Contribution to journalArticle

@article{4740496afeaa41d2b0a048fadcb9f63e,
title = "Risk factors associated with biochemically detected and hospitalised acute kidney injury in patients prescribed renin angiotensin system inhibitors",
abstract = "Aims Therapy with angiotensin converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) is a mainstay of treatment for heart failure (HF), diabetes mellitus (DM) and chronic kidney disease (CKD). These agents have been associated with development of acute kidney injury (AKI) during intercurrent illness. Risk factors for AKI in patients prescribed ACEi/ARB therapy are not well described.Methods We the incidence of AKI in patients commencing ACEi/ARB during 2009‐2015 using anonymised patient records. Hospital‐coded AKI was defined from hospital episode statistics; biochemical AKI was ascertained from laboratory data. Risk factors for biochemically detected and hospitalised AKI were investigated.Results Of 61,318 patients prescribed ACEi/ARB, with 132,885 person years (py) follow up, there were 1,070 hospitalisations with AKI as a diagnoses recorded and a total of 4,645 AKI events, including AKI episodes indicated by biochemical KDIGO‐based creatinine change criteria. Incidence of any AKI event was 35.0 per 1000‐ py, hospital‐coded AKI was 7.8 per 1000‐py and biochemical AKI was 33.7 per 1000‐py. Independent risk factors in a multivariable model for hospital‐coded AKI events were age, male gender, HF, diabetes, cerebrovascular disease, lower estimated glomerular filtration rate, socioeconomic deprivation, diuretic or non‐steroidal anti‐inflammatory use (all p<0.001).Conclusion In patients prescribed ACEi/ARB, the highest risk of AKI is associated with conditions which are considered strong evidence‐based indications for their prescription. Socio‐economic status is an under‐reported risk factor for AKI with these agents. Strategies targeted at prevention of AKI may be of benefit, such as enhanced awareness based on higher risk comorbidities.",
keywords = "acute kidney injury, angiotensin converting enzyme inhibitor, angiotensin receptor blocker, heart failure, chronic kidney disease",
author = "Mark, {Patrick B.} and Richard Papworth and Nitish Ramparsad and Laurie Tomlinson and Simon Sawhney and Corri Black and Alex McConnachie and Colin McCowan",
note = "Acknowledgments: The authors would like to thank Claire MacDonald from NHS Greater Glasgow and Clyde Safe Haven for technical assistance with the project. Funding: This work was funded by the Chief Scientist Office Scotland (grant HICG/1/1)",
year = "2020",
month = "1",
day = "3",
doi = "10.1111/bcp.14141",
language = "English",
journal = "British Journal of Clinical Pharmacology",
issn = "0306-5251",
publisher = "Wiley-Blackwell",

}

TY - JOUR

T1 - Risk factors associated with biochemically detected and hospitalised acute kidney injury in patients prescribed renin angiotensin system inhibitors

AU - Mark, Patrick B.

AU - Papworth, Richard

AU - Ramparsad, Nitish

AU - Tomlinson, Laurie

AU - Sawhney, Simon

AU - Black, Corri

AU - McConnachie, Alex

AU - McCowan, Colin

N1 - Acknowledgments: The authors would like to thank Claire MacDonald from NHS Greater Glasgow and Clyde Safe Haven for technical assistance with the project. Funding: This work was funded by the Chief Scientist Office Scotland (grant HICG/1/1)

PY - 2020/1/3

Y1 - 2020/1/3

N2 - Aims Therapy with angiotensin converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) is a mainstay of treatment for heart failure (HF), diabetes mellitus (DM) and chronic kidney disease (CKD). These agents have been associated with development of acute kidney injury (AKI) during intercurrent illness. Risk factors for AKI in patients prescribed ACEi/ARB therapy are not well described.Methods We the incidence of AKI in patients commencing ACEi/ARB during 2009‐2015 using anonymised patient records. Hospital‐coded AKI was defined from hospital episode statistics; biochemical AKI was ascertained from laboratory data. Risk factors for biochemically detected and hospitalised AKI were investigated.Results Of 61,318 patients prescribed ACEi/ARB, with 132,885 person years (py) follow up, there were 1,070 hospitalisations with AKI as a diagnoses recorded and a total of 4,645 AKI events, including AKI episodes indicated by biochemical KDIGO‐based creatinine change criteria. Incidence of any AKI event was 35.0 per 1000‐ py, hospital‐coded AKI was 7.8 per 1000‐py and biochemical AKI was 33.7 per 1000‐py. Independent risk factors in a multivariable model for hospital‐coded AKI events were age, male gender, HF, diabetes, cerebrovascular disease, lower estimated glomerular filtration rate, socioeconomic deprivation, diuretic or non‐steroidal anti‐inflammatory use (all p<0.001).Conclusion In patients prescribed ACEi/ARB, the highest risk of AKI is associated with conditions which are considered strong evidence‐based indications for their prescription. Socio‐economic status is an under‐reported risk factor for AKI with these agents. Strategies targeted at prevention of AKI may be of benefit, such as enhanced awareness based on higher risk comorbidities.

AB - Aims Therapy with angiotensin converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) is a mainstay of treatment for heart failure (HF), diabetes mellitus (DM) and chronic kidney disease (CKD). These agents have been associated with development of acute kidney injury (AKI) during intercurrent illness. Risk factors for AKI in patients prescribed ACEi/ARB therapy are not well described.Methods We the incidence of AKI in patients commencing ACEi/ARB during 2009‐2015 using anonymised patient records. Hospital‐coded AKI was defined from hospital episode statistics; biochemical AKI was ascertained from laboratory data. Risk factors for biochemically detected and hospitalised AKI were investigated.Results Of 61,318 patients prescribed ACEi/ARB, with 132,885 person years (py) follow up, there were 1,070 hospitalisations with AKI as a diagnoses recorded and a total of 4,645 AKI events, including AKI episodes indicated by biochemical KDIGO‐based creatinine change criteria. Incidence of any AKI event was 35.0 per 1000‐ py, hospital‐coded AKI was 7.8 per 1000‐py and biochemical AKI was 33.7 per 1000‐py. Independent risk factors in a multivariable model for hospital‐coded AKI events were age, male gender, HF, diabetes, cerebrovascular disease, lower estimated glomerular filtration rate, socioeconomic deprivation, diuretic or non‐steroidal anti‐inflammatory use (all p<0.001).Conclusion In patients prescribed ACEi/ARB, the highest risk of AKI is associated with conditions which are considered strong evidence‐based indications for their prescription. Socio‐economic status is an under‐reported risk factor for AKI with these agents. Strategies targeted at prevention of AKI may be of benefit, such as enhanced awareness based on higher risk comorbidities.

KW - acute kidney injury

KW - angiotensin converting enzyme inhibitor

KW - angiotensin receptor blocker

KW - heart failure

KW - chronic kidney disease

U2 - 10.1111/bcp.14141

DO - 10.1111/bcp.14141

M3 - Article

C2 - 31663151

JO - British Journal of Clinical Pharmacology

JF - British Journal of Clinical Pharmacology

SN - 0306-5251

ER -