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https://hdl.handle.net/2440/138039
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Type: | Journal article |
Title: | Angiotensin-converting enzyme inhibitor usage and acute kidney injury: A secondary analysis of RENAL study outcomes |
Author: | Wang, A.Y. Bellomo, R. Ninomiya, T. Lo, S. Cass, A. Jardine, M. Gallagher, M. |
Citation: | Nephrology, 2014; 19(10):617-622 |
Publisher: | Wiley |
Issue Date: | 2014 |
ISSN: | 1320-5358 1440-1797 |
Statement of Responsibility: | Amanda Y Wang, Rinaldo Bellomo, Toshiharu Ninomiya, Serigne Lo, Alan Cass, Meg Jardine, and Martin Gallagher, for The Renal Study Investigators and the Anzics Clinical Trials Group (South Australia: Royal Adelaide Hospital: Arthas Flabouris, Jason Edwards, Stephanie O’Connor and Justine Rivett) |
Abstract: | Aim: Acute kidney injury (AKI) is associated with increased mortality. While angiotensin-converting enzyme inhibitors (ACEI) are known to slow progression of chronic kidney disease, their role in AKI remains unclear. Methods: The Randomised Evaluation of Normal vs. Augmented Level Replacement Therapy (RENAL) study data were analysed according to ACEI use over time. The primary outcome was all-cause mortality at 90 days following randomisation. Analyses used a multivariate Cox model adjusted for either baseline or for time-dependent covariates, and a sensitivity analysis of patients surviving to at least the median time to ACEI initiation. Results: Of the 1463 participants with available data on ACE inhibitors usage, 142 (9.7%) received ACEI at least once during study data collection. Participants treated with ACEI were older (P = 0.02) and had less sepsis at baseline (P < 0.001). ACEI use was significantly associated with lower mortality at 90 days (HR 0.46, 95% CI 0.30-0.71, P < 0.001), and an increase in renal replacement therapy-free days (P < 0.001), intensive care unit-free days (P < 0.001) and hospital free-days (P < 0.001) after adjusting for baseline covariates. Using the time-dependent analysis, however, the effect of ACEI administration was not significant (HR 0.78, 95% CI 0.51-1.21, P = 0.3). The sensitivity analysis in day 8 survivors produced similar results. Conclusion: In the RENAL study cohort, the use of ACEI during the study was not common and, after adjustment for time-dependent covariates, was not significantly associated with reductions in mortality. Further assessment of the effect of ACEI use in AKI patients is needed. |
Keywords: | RENAL Study Investigators ANZICS Clinical Trials Group acute kidney injury; angiotensin-converting enzyme inhibitor; dialysis; mortality; prospective study |
Rights: | © 2014 Asian Pacific Society of Nephrology |
DOI: | 10.1111/nep.12284 |
Grant ID: | http://purl.org/au-research/grants/nhmrc/632811 |
Published version: | http://dx.doi.org/10.1111/nep.12284 |
Appears in Collections: | Medicine publications |
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