title: Rates and predictors of ACE inhibitor discontinuation subsequent to elevated serum creatinine: a retrospective cohort study.
abstract: OBJECTIVE
  ACE inhibitors (ACEI) are underutilised despite cardiovascular benefits, in part due to concerns of known transient elevations in serum creatinine (SCr) after initiation. Our objectives were to evaluate rates and predictors of ACEI discontinuation after SCr elevation post-ACEI initiation since limited data are available that examine this issue.
  
  
  METHODS
  Primary and tertiary Veterans healthcare system in Los Angeles, California, USA PARTICIPANTS: 3039 outpatients initiating an ACEI with a SCr measured within 6 months prior to and approximately 3 months after initiating an ACEI. Patients were divided into three groups (SCr <1.5, 1.5–2 and >2).
  
  
  METHODS
  Rates and factors associated with ACEI discontinuation subsequent to SCr elevation after ACEI initiation and for patients with baseline SCr >2 mg/dL, the change in SCr associated with chronic use. Predictors were identified using multivariate logistic regression modelling.
  
  
  RESULTS
  At 3 months follow-up, for those with an increase in SCr, the mean increase post-ACEI initiation was 26%, ranging from −0.01 mg/dL to 0.42 mg/dL varying according to a level of baseline renal function. ACEI discontinuation was higher in patients with elevated baseline SCr (19/165, 11.5%) compared with those with SCr <1.5 (135/2497, 5.4%), and those with SCr 1.5–2.0 (28/377, 7.4%). Male patients, and those with heart failure were less likely to discontinue ACEI after an elevation of SCr post-ACEI initiation, while those taking non-steroidal anti-inflammatory drugs, diuretics and β-blockers were more likely to discontinue ACEI.
  
  
  CONCLUSIONS
  SCr increases <30% on average within 3 months of ACEI initiation, with subsequent discontinuation rates varying by baseline SCr. Elevation in SCr was not associated with ACEI discontinuation rates. In patients with SCr >2 mg/dL at baseline, despite an acute increase in SCr after ACEI initiation, chronic ACEI use was associated with a decrease in SCr in most patients.
authors.forename: Cynthia A
authors.initials: CA
authors.lastname: Jackevicius
authors.forename: Joyce
authors.initials: J
authors.lastname: Wong
authors.forename: Irina
authors.initials: I
authors.lastname: Aroustamian
authors.forename: Manyee
authors.initials: M
authors.lastname: Gee
authors.forename: Freny Vaghaiwalla
authors.initials: FV
authors.lastname: Mody
mesh_terms: D000328:Adult; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D002140:California / Q000453:epidemiology; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood*; D003925:Diabetic Angiopathies / Q000188:drug therapy* / Q000453:epidemiology; D018450:Disease Progression; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006333:Heart Failure / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011188:Potassium / Q000097:blood*; D016032:Randomized Controlled Trials as Topic; D051437:Renal Insufficiency / Q000097:blood / Q000139:chemically induced*; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D003404:Creatinine; D011188:Potassium