Association between peri‐operative angiotensin‐converting enzyme inhibitors and angiotensin‐2 receptor blockers and acute kidney injury in major elective non‐cardiac surgery: a multicentre, prospective cohort study

• Published in: Anaesthesia Vol. 73; no. 10; pp. 1214 - 1222
• Main Authors: Gaba, Fortis, Harrison, Ewen M, Drake, TM, Burke, Joshua, McLean, Kenneth A, Arulkumaran, Nishkantha, Attalla, M, Chouari, T, Mah, T, Lang‐Orsini, M, Arthur, J, Barclay, J, Kelly, D, Lam, J, Qamar, I, McCusker, C, Ferris, B, Harty, M, McGinnity, K, Ang, A, Mutarambirwa, A, Vig, S, McMenamin, L, Cope, T, Patel, A, Auluck, I, Yeo, A, Aubrey‐Jones, D, Lazarou, A, Cumming, S, Khan, S, Lu Morrell, B, Cant, M, Das, K, Puddy, H, Dhillon, P, Ecclestone, T, Wong, E, Capella, S, Episkopos, C, Hussein, N, Perris, R, Hollington, D, Worsfold, M, Diamond, J, Ibrahim, B, Neo, Y N, Peck, F S, Curtis, J, Green, S, Duff, F, Ali, S, Livie, J, Haray, P, Oji, O, Stageman, N, Matthews, J H, Modhwadia, S, Bachi, A, Bhatti, A, Maxwell‐Armstrong, C, Michaelidou, M, Svolkinas, D, Wang, H, Rangarajan, S, Kennedy, E D, Chean, C S, Chudek, D, Townsend, D, Phillips, C F E, Benons, N, Tan, S, Stubbing‐Moore, A, Gower, T, Rutler, L, Ward, N, Chauhan, P, Eilon, T, York, J, Knight, J S, Tam, J P, Ashwood, J, Selvadurai, S, Ahern, D, Kenefick, N, Saito, R, Thomas, O, Tan, L C, Draper, A, Harrison, P, Luk, Y L, Swan, A, Balian, V, Arya, J, Roy, C, Siddiqui, A, Wakeford, W, Mathew, G, Beattie, G, Sandland‐Taylor, L
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.10.2018
• Subjects: acute kidney injury; Acute Kidney Injury - chemically induced; Acute Kidney Injury - epidemiology; Acute Kidney Injury - prevention & control; Aged; Aged, 80 and over; Angiotensin; angiotensin II receptor blockers; Angiotensin Receptor Antagonists - administration & dosage; Angiotensin Receptor Antagonists - adverse effects; Angiotensin-Converting Enzyme Inhibitors - administration & dosage; Angiotensin-Converting Enzyme Inhibitors - adverse effects; angiotensin‐converting enzyme inhibitors; Cohort analysis; Comorbidity; Conversion; Digestive System Surgical Procedures - adverse effects; Drug Administration Schedule; Elective Surgical Procedures - adverse effects; Enzyme inhibitors; Enzymes; Female; Gastrointestinal system; Gastrointestinal tract; Health risks; Heart; Humans; Injury prevention; Ireland - epidemiology; Kidneys; Male; Matching; Middle Aged; Patients; Perioperative Care - methods; postoperative complications; Postoperative Complications - chemically induced; Postoperative Complications - epidemiology; Postoperative Complications - prevention & control; Prospective Studies; Risk; Risk Factors; Surgery; United Kingdom - epidemiology; Withholding Treatment; United Kingdom; Ireland; postoperative complications; angiotensin-converting enzyme inhibitors; acute kidney injury; angiotensin II receptor blockers
• ISSN: 0003-2409; 1365-2044
• DOI: 10.1111/anae.14349

Summary The peri‐operative use of angiotensin‐converting enzyme inhibitors or angiotensin‐2 receptor blockers is thought to be associated with an increased risk of postoperative acute kidney injury. To reduce this risk, these agents are commonly withheld during the peri‐operative period. This study aimed to investigate if withholding angiotensin‐converting enzyme inhibitors or angiotensin‐2 receptor blockers peri‐operatively reduces the risk of acute kidney injury following major non‐cardiac surgery. Patients undergoing elective major surgery on the gastrointestinal tract and/or the liver were eligible for inclusion in this prospective study. The primary outcome was the development of acute kidney injury within seven days of operation. Adjusted multi‐level models were used to account for centre‐level effects and propensity score matching was used to reduce the effects of selection bias between treatment groups. A total of 949 patients were included from 160 centres across the UK and Republic of Ireland. From this population, 573 (60.4%) patients had their angiotensin‐converting enzyme inhibitors or angiotensin‐2 receptor blockers withheld during the peri‐operative period. One hundred and seventy‐five (18.4%) patients developed acute kidney injury; there was no difference in the incidence of acute kidney injury between patients who had their angiotensin‐converting enzyme inhibitors or angiotensin‐2 receptor blockers continued or withheld (107 (18.7%) vs. 68 (18.1%), respectively; p = 0.914). Following propensity matching, withholding angiotensin‐converting enzyme inhibitors or angiotensin‐2 receptor blockers did not demonstrate a protective effect against the development of postoperative acute kidney injury (OR (95%CI) 0.89 (0.58–1.34); p = 0.567).