PT - JOURNAL ARTICLE AU - Brar, Sandeep AU - Liu, Kathleen D. AU - Go, Alan S. AU - Hsu, Raymond K. AU - Chinchilli, Vernon M. AU - Coca, Steven G. AU - Garg, Amit X. AU - Himmelfarb, Jonathan AU - Ikizler, T. Alp AU - Kaufman, James AU - Kimmel, Paul L. AU - Parikh, Chirag R. AU - Siew, Edward D. AU - Ware, Lorraine B. AU - Zeng, Hui AU - Hsu, Chi-yuan AU - , TI - Prospective Cohort Study of Renin-Angiotensin System Blocker Usage after Hospitalized Acute Kidney Injury AID - 10.2215/CJN.10840720 DP - 2021 Jan 07 TA - Clinical Journal of the American Society of Nephrology PG - 26--36 VI - 16 IP - 1 4099 - http://cjasn.asnjournals.org/content/16/1/26.short 4100 - http://cjasn.asnjournals.org/content/16/1/26.full SO - CLIN J AM SOC NEPHROL2021 Jan 07; 16 AB - Background and objectives The risk-benefit ratio of angiotensin-converting enzyme inhibitor or angiotensin receptor blocker therapy after AKI may be altered due to concerns regarding recurrent AKI. We evaluated, in a prospective cohort, the association between use (versus nonuse) of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and the subsequent risk of AKI and other adverse outcomes after hospitalizations with and without AKI.Design, setting, participants, & measurements We studied 1538 patients recently discharged from the hospital who enrolled in the multicenter, prospective ASSESS-AKI study, with approximately half of patients experiencing AKI during the index hospitalization. All participants were seen at a baseline visit 3 months after their index hospitalization and were categorized at that time on whether they were using angiotensin-converting enzyme inhibitors/angiotensin receptor blockers or not. We used multivariable Cox regression, adjusting for demographics, comorbidities, eGFR, urine protein-creatinine ratio, and use of other medications, to examine the association between angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use and subsequent risks of AKI, death, kidney disease progression, and adjudicated heart-failure events.Results The use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers was 50% (386/769) among those with AKI during the index hospitalization and 47% (362/769) among those without. Among those with AKI during the index hospitalization, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use was not associated with a higher risk of recurrent hospitalized AKI (adjusted hazard ratio, 0.88; 95% confidence interval, 0.69 to 1.13). Associations between angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use and death, kidney disease progression, and adjudicated heart-failure events appeared similar in study participants who did and did not experience AKI during the index hospitalization (all interaction P values >0.05).Conclusions The risk-benefit ratio of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker therapy after hospital discharge appears to be similar regardless of whether AKI occurred during the hospitalization.