Impact of angiotensin-converting enzyme inhibitors or receptor blockers on post-ICU discharge outcome in patients with acute kidney injury.
Intensive Care Med. 2018 May; 44(5):598-605.IC

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.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Gayat E

Department of Anaesthesiology, Critical Care Medicine and Burn Unit, Saint Louis and Lariboisière University Hospitals, AP-HP, 2 rue A. Paré, 75010, Paris, France. Institut National de la Santé et de la Recherche Médicale (INSERM), Lariboisière Hospital and INI-CRCT Network, INSERM UMR-S942, Paris, France. University Paris Diderot, 75475, Paris, France.

Hollinger A

Cariou A

Medical Intensive Care Unit, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.

Deye N

Institut National de la Santé et de la Recherche Médicale (INSERM), Lariboisière Hospital and INI-CRCT Network, INSERM UMR-S942, Paris, France. Medical and Toxicological Intensive Care Unit, Lariboisière Hospital, Université Paris Sorbonne Cité, Paris Diderot, Assistance Publique des Hôpitaux de Paris, Paris, France.

Vieillard-Baron A

Intensive Care Unit, University Hospital Ambroise Paré, Assistance Publique-Hopitaux de Paris, 26930, Boulogne-Billancourt, France. INSERM U-1018, CESP, Team 5, University of Versailles Saint-Quentin en Yvelines, Villejuif, France. Faculty of Medicine Paris Ile-de-France Ouest, University of Versailles Saint-Quentin en Yvelines, Saint-Quentin en Yvelines, France.

Jaber S

Intensive Care Unit, Anaesthesia and Critical Care Department, Saint Eloi Teaching Hospital, Centre Hospitalier Universitaire Montpellier, Montpellier University, Montpellier, France.

Chousterman BG

Department of Anaesthesiology, Critical Care Medicine and Burn Unit, Saint Louis and Lariboisière University Hospitals, AP-HP, 2 rue A. Paré, 75010, Paris, France.

Lu Q

Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care Medicine, La Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris, UPMC Paris 6, Paris, France.

Laterre PF

Department of Critical Care Medicine, Saint Luc University Hospital, Université Catholique de Louvain, Avenue Hippocrate 10, 1200, Brussels, Belgium.

Monnet X

Medical Intensive Care Unit, Bicêtre Hospital, Paris-Sud University Hospitals, Inserm UMR_S999, Paris-Sud University, Le Kremlin-Bicêtre, France.

Darmon M

Medical ICU, St-Louis Hospital, Université Paris Sorbonne Cité, Paris Diderot, Assistance Publique des Hôpitaux de Paris, Paris, France.

Leone M

Service d'anesthésie et de réanimation, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix Marseille Université, Marseille, France.

Guidet B

Service de Réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France.

Sonneville R

Medical ICU, Bichat Hospital, Université Paris Sorbonne Cité, Paris Diderot, Assistance Publique des Hôpitaux de Paris, Paris, France.

Lefrant JY

Department of Anesthesiology, Critical Care, Emergency and Pain Medicine, Nimes University Hospital, 30029, Nîmes, France.

Fournier MC

Resche-Rigon M

ECSTRA Team, INSERM, Service de biostatistique et information Médicale, Hôpitaux Universitaires St-Louis-Lariboisière, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot-Paris 7, Sorbonne Paris Cité, Paris, France.

Mebazaa A

Legrand M

Department of Anaesthesiology, Critical Care Medicine and Burn Unit, Saint Louis and Lariboisière University Hospitals, AP-HP, 2 rue A. Paré, 75010, Paris, France. matthieu.legrand@aphp.fr. Institut National de la Santé et de la Recherche Médicale (INSERM), Lariboisière Hospital and INI-CRCT Network, INSERM UMR-S942, Paris, France. matthieu.legrand@aphp.fr. University Paris Diderot, 75475, Paris, France. matthieu.legrand@aphp.fr.

FROG-ICU investigators

No affiliation info available

MeSH

Acute Kidney InjuryAgedAged, 80 and overAngiotensin Receptor AntagonistsAngiotensin-Converting Enzyme InhibitorsCohort StudiesDrug-Related Side Effects and Adverse ReactionsFemaleHumansMaleMiddle AgedRenal Insufficiency, Chronic

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29766216

Clinical Trial Links

Clinical trial which this article describes

Impact of a Treatment With Angiotensin Receptor Blocker on Outcome After Acute Kidney Injury in Patients Discharged From the ICU.

Citation

Gayat, Etienne, et al. "Impact of Angiotensin-converting Enzyme Inhibitors or Receptor Blockers On post-ICU Discharge Outcome in Patients With Acute Kidney Injury." Intensive Care Medicine, vol. 44, no. 5, 2018, pp. 598-605.

Gayat E, Hollinger A, Cariou A, et al. Impact of angiotensin-converting enzyme inhibitors or receptor blockers on post-ICU discharge outcome in patients with acute kidney injury. Intensive Care Med. 2018;44(5):598-605.

Gayat, E., Hollinger, A., Cariou, A., Deye, N., Vieillard-Baron, A., Jaber, S., Chousterman, B. G., Lu, Q., Laterre, P. F., Monnet, X., Darmon, M., Leone, M., Guidet, B., Sonneville, R., Lefrant, J. Y., Fournier, M. C., Resche-Rigon, M., Mebazaa, A., & Legrand, M. (2018). Impact of angiotensin-converting enzyme inhibitors or receptor blockers on post-ICU discharge outcome in patients with acute kidney injury. Intensive Care Medicine, 44(5), 598-605. https://doi.org/10.1007/s00134-018-5160-6

Gayat E, et al. Impact of Angiotensin-converting Enzyme Inhibitors or Receptor Blockers On post-ICU Discharge Outcome in Patients With Acute Kidney Injury. Intensive Care Med. 2018;44(5):598-605. PubMed PMID: 29766216.

* Article titles in AMA citation format should be in sentence-case

TY - JOUR T1 - Impact of angiotensin-converting enzyme inhibitors or receptor blockers on post-ICU discharge outcome in patients with acute kidney injury. AU - Gayat,Etienne, AU - Hollinger,Alexa, AU - Cariou,Alain, AU - Deye,Nicolas, AU - Vieillard-Baron,Antoine, AU - Jaber,Samir, AU - Chousterman,Benjamin G, AU - Lu,Qin, AU - Laterre,Pierre François, AU - Monnet,Xavier, AU - Darmon,Michael, AU - Leone,Marc, AU - Guidet,Bertrand, AU - Sonneville,Romain, AU - Lefrant,Jean-Yves, AU - Fournier,Marie-Céline, AU - Resche-Rigon,Matthieu, AU - Mebazaa,Alexandre, AU - Legrand,Matthieu, AU - ,, Y1 - 2018/05/15/ PY - 2018/02/26/received PY - 2018/03/30/accepted PY - 2018/5/17/pubmed PY - 2019/11/5/medline PY - 2018/5/17/entrez KW - Acute kidney injury KW - Angiotensin-converting enzyme inhibitors KW - Angiotensin-receptor blockers KW - Critically Ill KW - ICU KW - ICU discharge KW - Mortality SP - 598 EP - 605 JF - Intensive care medicine JO - Intensive Care Med VL - 44 IS - 5 N2 - 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. SN - 1432-1238 UR - https://www.unboundmedicine.com/medline/citation/29766216/Impact_of_angiotensin_converting_enzyme_inhibitors_or_receptor_blockers_on_post_ICU_discharge_outcome_in_patients_with_acute_kidney_injury_ DB - PRIME DP - Unbound Medicine ER -

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Impact of angiotensin-converting enzyme inhibitors or receptor blockers on post-ICU discharge outcome in patients with acute kidney injury.Intensive Care Med. 2018 May; 44(5):598-605.IC