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Published in: BMC Nephrology 1/2014

Open Access 01-12-2014 | Research article

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

Authors: Mitesh Shah, Arsh K Jain, Steven M Brunelli, Steven G Coca, Philip J Devereaux, Matthew T James, Jin Luo, Amber O Molnar, Marko Mrkobrada, Neesh Pannu, Chirag R Parikh, Michael Paterson, Salimah Shariff, Ron Wald, Michael Walsh, Richard Whitlock, Duminda N Wijeysundera, Amit X Garg

Published in: BMC Nephrology | Issue 1/2014

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Abstract

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.
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Metadata
Title
Association between angiotensin converting enzyme inhibitor or angiotensin receptor blocker use prior to major elective surgery and the risk of acute dialysis
Authors
Mitesh Shah
Arsh K Jain
Steven M Brunelli
Steven G Coca
Philip J Devereaux
Matthew T James
Jin Luo
Amber O Molnar
Marko Mrkobrada
Neesh Pannu
Chirag R Parikh
Michael Paterson
Salimah Shariff
Ron Wald
Michael Walsh
Richard Whitlock
Duminda N Wijeysundera
Amit X Garg
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Nephrology / Issue 1/2014
Electronic ISSN: 1471-2369
DOI
https://doi.org/10.1186/1471-2369-15-53

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