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01-05-2018 | Seven-Day Profile Publication

Impact of angiotensin-converting enzyme inhibitors or receptor blockers on post-ICU discharge outcome in patients with acute kidney injury

Authors: Etienne Gayat, Alexa Hollinger, Alain Cariou, Nicolas Deye, Antoine Vieillard-Baron, Samir Jaber, Benjamin G. Chousterman, Qin Lu, Pierre François Laterre, Xavier Monnet, Michael Darmon, Marc Leone, Bertrand Guidet, Romain Sonneville, Jean-Yves Lefrant, Marie-Céline Fournier, Matthieu Resche-Rigon, Alexandre Mebazaa, Matthieu Legrand, On behalf of FROG-ICU investigators

Published in: Intensive Care Medicine | Issue 5/2018

Abstract

Purpose

Acute kidney injury (AKI) is associated with the activation of the renin–angiotensin system. Whether angiotensin-converting enzyme inhibitors (ACEi) or angiotensin-receptor blockers (ARB) improve outcome in patients recovering from AKI remains unexplored. The purpose was to investigate the association between prescription of ACEi/ARB at intensive care unit (ICU) discharge and 1-year outcome in patients recovering from AKI.

Methods

Association between ACEi/ARB and 1-year mortality rate was explored in 1551 patients discharged from 21 European ICUs in an observational cohort. One-year all-cause mortality after ICU discharge was the primary endpoint. AKI was defined using the kidney disease improvement global outcome definition. Propensity score matching was used to consider the probability to receive ACEi/ARB at ICU discharge and included chronic heart failure, ACEi/ARB on ICU admission, Charlson Comorbidity Index, age, diabetes mellitus, chronic kidney disease, estimated glomerular filtration rate and arterial blood pressure at ICU discharge vasopressors and renal replacement therapy.

Results

Overall, 1-year mortality was 28 and 15% in patients with AKI (n = 611, 39%) and without AKI (n = 940), respectively. In patients with AKI, unadjusted, adjusted and propensity-score matched 1-year mortality rates were lower in patients treated with ACEi/ARB at ICU discharge [HR of 0.55 (0.35–0.89), HR of 0.45 (0.27–0.75), and HR of 0.48 (0.27–0.85, p < 0.001), respectively]. These results were consistent across sensitivity analysis. No association was observed in patients without AKI.

Conclusions

In patients discharged alive from the ICU after experiencing AKI, ACEi/ARB prescription at discharge is associated with a decrease in 1-year mortality.

Trial registration

ClinicalTrials.gov NCT01367093. Registered on 6 June 2011.

Available only for authorised users

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Title: Impact of angiotensin-converting enzyme inhibitors or receptor blockers on post-ICU discharge outcome in patients with acute kidney injury
Authors: Etienne Gayat
Alexa Hollinger
Alain Cariou
Nicolas Deye
Antoine Vieillard-Baron
Samir Jaber
Benjamin G. Chousterman
Qin Lu
Pierre François Laterre
Xavier Monnet
Michael Darmon
Marc Leone
Bertrand Guidet
Romain Sonneville
Jean-Yves Lefrant
Marie-Céline Fournier
Matthieu Resche-Rigon
Alexandre Mebazaa
Matthieu Legrand
On behalf of FROG-ICU investigators
Publication date: 01-05-2018
Publisher: Springer Berlin Heidelberg
Published in: Intensive Care Medicine / Issue 5/2018
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-018-5160-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Impact of angiotensin-converting enzyme inhibitors or receptor blockers on post-ICU discharge outcome in patients with acute kidney injury

Abstract

Purpose

Methods

Results

Conclusions

Trial registration

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Trial registration

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