Association between angiotensin converting enzyme inhibitor or angiotensin receptor blocker use prior to major elective surgery and the risk of acute dialysis

BMC Nephrology

Amit X Garg³  Duminda N Wijeysundera⁴  Richard Whitlock³  Michael Walsh³  Ron Wald¹  Salimah Shariff²  Michael Paterson⁴  Chirag R Parikh⁶  Neesh Pannu^1,10  Marko Mrkobrada⁷  Amber O Molnar⁸  Jin Luo⁴  Matthew T James^1,11  Philip J Devereaux⁵  Steven G Coca⁶  Steven M Brunelli²  Arsh K Jain⁴  Mitesh Shah⁹ 

[1] Division of Nephrology, University of Toronto, Toronto, Canada;Renal Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, USA;Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada;Institute for Clinical Evaluative Sciences, Ontario, Canada;Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Canada;Section of Nephrology, Yale University School of Medicine, New Haven, USA;Department of Medicine, Western University, London, Canada;Division of Nephrology, University of Ottawa, Ottawa, Canada;Divisions of Clinical Epidemiology and Internal Medicine, McGill University, Montreal, Canada;Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Canada;Department of Medicine, University of Calgary, Hamilton, Canada

关键词: Major elective surgery;    Angiotensin receptor blocker;    Angiotensin converting enzyme inhibitor;    Acute dialysis;   

Others  :  1082707
DOI  :  10.1186/1471-2369-15-53

 received in 2013-10-16, accepted in 2014-03-28,  发布年份 2014

【 摘 要 】

Background

Some studies but not others suggest angiotensin converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB) use prior to major surgery associates with a higher risk of postoperative acute kidney injury (AKI) and death.

Methods

We conducted a large population-based retrospective cohort study of patients aged 66 years or older who received major elective surgery in 118 hospitals in Ontario, Canada from 1995 to 2010 (n = 237,208). We grouped the cohort into ACEi/ARB users (n = 101,494) and non-users (n = 135,714) according to whether the patient filled at least one prescription for an ACEi or ARB (or not) in the 120 days prior to surgery. Our study outcomes were acute kidney injury treated with dialysis (AKI-D) within 14 days of surgery and all-cause mortality within 90 days of surgery.

Results

After adjusting for potential confounders, preoperative ACEi/ARB use versus non-use was associated with 17% lower risk of post-operative AKI-D (adjusted relative risk (RR): 0.83; 95% confidence interval (CI): 0.71 to 0.98) and 9% lower risk of all-cause mortality (adjusted RR: 0.91; 95% CI: 0.87 to 0.95). Propensity score matched analyses provided similar results. The association between ACEi/ARB and AKI-D was significantly modified by the presence of preoperative chronic kidney disease (CKD) (P value for interaction < 0.001) with the observed association evident only in patients with CKD (CKD - adjusted RR: 0.62; 95% CI: 0.50 to 0.78 versus No CKD: adjusted RR: 1.00; 95% CI: 0.81 to 1.24).

Conclusions

In this cohort study, preoperative ACEi/ARB use versus non-use was associated with a lower risk of AKI-D, and the association was primarily evident in patients with CKD. Large, multi-centre randomized trials are needed to inform optimal ACEi/ARB use in the peri-operative setting.

【 授权许可】

   
2014 Shah et al.; licensee BioMed Central Ltd.

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