Back
It is consensus that renin-angiotensin system inhibitors (RASi) are a pillar of drugs used for cardiovascular and renal protection, however their effects during an AKI episode are still controversial and most guidelines suggest their discontinuation. The aim of the study is to compare the mortality of hospitalized patients with cardiovascular diseases who developed AKI and discontinued the inhibitors with those who maintained their use.
Data were analyzed from a cohort of patients admitted to tertiary and university hospital in Brazil with cardiovascular disease (coronary artery disease and heart failure) identified by an AKI electronic alert, in 2018 and 2020, who were using RASi. Discontinuation of RASi was defined as the suspension of their prescription for up to 3 days after the AKI alert. We used a Poisson model to estimate the adjusted risk of death predicted by RASi discontinuation. Age, race, sex, comorbidities (obesity, diabetes mellitus, high blood pressure, heart failure and coronary artery disease), ICU admission and renal replacement therapy were used as possible confounding factors.
Our cohort consisted of 551 patients, with a mean age of 69±11,8 years of age with 56% male. Of the patients there were using RASi within 24 hours of the AKI alert, 241 (43,7%) remained off the medications 72 hours later. The patients that discontinued RASi had a greater risk of death (28% vs 20%) when compared to the patients who remained using them. When accounting for possible confounders, the risk of death for the RASi discontinuation group was 45% higher (RR=1.45 (1.07, 1.95)) than for those that remained using the drugs.
This analysis underscores that RASi should not be withdrawn routinely in patients with cardiovascular disease who develop AKI during hospitalization. While acknowledging the existence of certain limitations, it is worth noting that a strategy of discontinuation may be associated with higher mortality.