https://scholars.lib.ntu.edu.tw/handle/123456789/620413
Title: | Angiotensin II Receptor Blocker Associated With Less Outcome Risk in Patients With Acute Kidney Disease | Authors: | VIN-CENT WU YU-FENG LIN Teng, Nai-Chi SHAO-YU YANG NAI-KUAN CHOU Tsao, Chun-Hao YUNG-MING CHEN Chueh, Jeff S Chen, Likwang NSARF group |
Keywords: | ACEi;AKD;AKI;ARB;dialysis;hyperkalemia;mortality;weaning | Issue Date: | 2022 | Publisher: | Frontiers Media S.A. | Journal Volume: | 13 | Start page/Pages: | 714658 | Source: | Frontiers in Pharmacology | Abstract: | Objective: The aim of this study was to explore the respective use of angiotensin-converting-enzyme inhibitors (ACEis) or angiotensin receptor blockers (ARBs) on the outcomes of patients who could be weaned from dialysis-requiring acute kidney injury (AKI-D). Methods: This case–control study enrolled 41,731 patients who were weaned from AKI-D for at least 7 days from Taiwan’s National Health Insurance Administration. We further grouped AKI-D patients according to ACEi and ARB use to evaluate subsequent risks of all-cause mortality and re-dialysis. The outcomes included the all-cause mortality and new-onset of end-stage kidney disease (ESKD; re-dialysis) following withdraw from AKI-D. Results: A total of 17,141 (41.1%) patients surviving AKI-D could be weaned from dialysis for at least 7 days. The overall events of mortality were 366 (48.9%) in ACEi users, 659 (52.1%) in ARB users, and 6,261 (41.3%) in ACEi/ARB nonusers, during a mean follow-up period of 1.01 years after weaning from AKI-D. In regard to all-cause of mortality, pre-dialysis ARB users had lower incidence than ACEi users [hazard ratio (HR 0.82), p = 0.017]. Compared with ACEi/ARB nonusers, continuing ARB users had a significantly low risk of long-term all-cause mortality (adjusted hazard ratio 0.51, p = 0.013) after propensity score matching. However, new users of ACEi at the acute kidney disease (AKD) period had a higher risk of re-dialysis after weaning than ACEi/ARB nonusers (aHR 1.82, p < 0.001), whereas neither ACEi nor ARB users confronted significantly increased risks of hyperkalemia after weaning. Conclusions: Compared with patients without ACEi/ARB, those continuing to use ARB before the event and after weaning had low all-cause mortality, while new users of ACEi at AKD had increased risk of re-dialysis. AKI-D patients continuing to use ACEi or ARB did not have higher risk of hyperkalemia. Future prospective randomized trials are expected to confirm these findings. Copyright © 2022 Wu, Lin, Teng, Yang, Chou, Tsao, Chen, Chueh and Chen. |
URI: | https://www.scopus.com/inward/record.uri?eid=2-s2.0-85131349117&doi=10.3389%2ffphar.2022.714658&partnerID=40&md5=9d08df682058eb7e22fec67cc3c976b3 https://scholars.lib.ntu.edu.tw/handle/123456789/620413 |
ISSN: | 1663-9812 | DOI: | 10.3389/fphar.2022.714658 |
Appears in Collections: | 醫學系 |
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