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  - for the ASsessment, Serial Evaluation, and Subsequent Sequelae in Acute Kidney Injury (ASSESS-AKI) study investigators
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.