SCM15: ACEi/ARBs and AKI: Any Benefit?

Dr. Christian Suarez-FuentesDr. Christian Suarez-Fuentes (CS), from Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, discusses his abstract for the National Kidney Foundation’s 2015 Spring Clinical Meetings (SCM15), Use of Renin Angiotensin Aldosterone System Blockade (RAASB) May Be Beneficial in Patients with Acute Kidney Injury (AKI), with Dr. Kenar Jhaveri, AJKD Blog Editor.

AJKDblog: Why don’t you tell us a little about your research and abstract being presented at the NKF 2015 Spring Meetings?

CS: We performed this study to better understand whether renin angiotensin aldosterone system blockade (RAASB) is a risk factor for developing acute kidney injury (AKI) in hospitalized patients. We gathered data on every adult patient admitted to the Montefiore Medical Center, Bronx, NY (Albert Einstein Medical School) for any reason between 2008 and 2010. We collected data on 46,580 patients.  All of the participants involved in our research had to have a documented baseline creatinine within 6 months prior to their admission. We defined AKI-Risk as a 50% creatinine increase from the baseline value. We collected data on different exposures including hypotension, sepsis, respiratory failure, serum albumin, Charlson comorbidity scores, antibiotics and others. We also obtained one year mortality data through linkage to the Social Security Administration Database.

Our results show that the incidence of AKI in our institution was 4.5% and that AKI increases the risk of yearly mortality in hospitalized patients. We found that RAASB was not associated with AKI-Risk overall. RAASB exposure was not associated with AKI-Risk in patients with congestive heart failure (CHF), diabetes mellitus or chronic kidney disease (CKD) stages 3 or 4 at baseline.  In addition, patients with exposure to RAASB had a lower risk of overall mortality compared to the patients who did not receive RAASB independent of AKI-Risk. Among patients with AKI, the worst survival rate was seen in patients who did not receive RAASB.

AJKDblog: These findings are counter to what most of us practice? Do you think these findings will change practice?

CS: When hospitalized patients develop AKI and are on RAASB, physicians usually discontinue these medications as it has commonly been believed that they may worsen the severity of AKI. We do not suggest that this practice should be changed based on our observational study but if RAASB is discontinued during an episode of AKI, clinicians should restart these medications as soon as possible.

AJKDblog: Where do you and your group go from here?

CS: There is limited data regarding the effects of RAASB in AKI. We do believe that further research is needed on this topic and hope that our study leads other researchers to explore this important topic. We believe that the major area to focus on is probably in patients with congestive heart failure because there is a clear mortality benefit from RAASB in that group. In particular, we are interested on further evaluating possible benefits that RAASB may provide in AKI in the congestive heart failure patient population.

Click here for a full list of SCM15 abstracts of poster presentations.

Check out more AJKDblog coverage of the NKF’s 2015 Spring Clinical Meetings!


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