Estimating the risk of acute kidney injury associated with use of diuretics and renin angiotensin aldosterone system inhibitors: A population based cohort study using the clinical practice research datalink

• Published in: BMC nephrology Vol. 20; no. 1; p. 481
• Main Authors: Scott, Jemima, Jones, Tim, Redaniel, Maria Theresa, May, Margaret T, Ben-Shlomo, Yoav, Caskey, Fergus
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 30.12.2019; BioMed Central; BMC
• Subjects: Acute kidney injury; Age; Aldosterone; Angiotensin; Angiotensins; Antihypertensives; Blood pressure; Cardiovascular disease; Chronic illnesses; Clinical medicine; Codes; Cohort analysis; Comorbidity; Data collection; Diabetes; Diuretics; Glucocorticoids; Health aspects; Health risk assessment; Hospital patients; Hospitals; Hypertension; Kidney diseases; Kidneys; Medical coding; Medical records; Mortality; Nephrology; Patients; Population studies; Population-based studies; Practice research; Registration; Renin; Renin-angiotension-aldosterone inhibitors; Retirement benefits; Statistical analysis; Studies; United Kingdom; United Kingdom; United Kingdom > UK; Renin-angiotension-aldosterone inhibitors; Diuretics; Acute kidney injury
• ISSN: 1471-2369; 1471-2369
• DOI: 10.1186/s12882-019-1633-2

The risk of acute kidney injury (AKI) attributable to renin angiotensin aldosterone (RAAS) inhibitors and diuretics remains unclear. We conducted a prospective cohort study using the Clinical Practice Research Datalink (2008-2015) linked to Hospital Episode Statistics - Admitted Patient Care and Office for National Statistics mortality data. Patients were included if they had one or more chronic diagnoses requiring medication. Exposed patients had a first ever prescription for RAAS inhibitors/diuretics during the study period. AKI risk associated with exposure was determined by multivariable Cox regression, propensity score-adjusted Cox regression and a prior event rate ratio (PERR) analysis. One hundred forty thousand nine hundred fifty-two individuals were included. Increased AKI risk in the exposed group was demonstrated in both the multivariable and propensity score-adjusted cox regressions (HR 1.23 (95% CI 1.04-1.45) and HR 1.24 (1.05-1.47) respectively). The PERR analysis provided a similar overall hazard ratio with a wider confidence interval (HR 1.29 (0.94-1.63)). The increased AKI risk in the exposed group was present only in those receiving two or more antihypertensives. Absolute AKI risk was small. RAAS inhibitors/diuretics result in an increased risk of AKI. The absolute increase in AKI risk is small, however, and needs to be considered in the context of any potential benefits.