Acute Kidney Injury in Patients Continued on Renin-Angiotensin System Blockers During Hospitalization.
BACKGROUND
Acute kidney injury (AKI) is common in hospitalized patients and is associated with adverse outcomes. This study aimed to evaluate patient characteristics and interventions during hospitalization associated with the development of AKI in patients continued on renin-angiotensin system (RAS) blockers during hospitalization.


METHODS
A retrospective study of 184 adult patients admitted between January 2012 and September 2014 and continued on RAS blockers was conducted. Risk factors for AKI were compared between AKI (n = 92) and non-AKI (n = 92) groups.


RESULTS
Patients who developed hospital-acquired AKI had a higher baseline serum creatinine (1.2 ± 0.4 versus 1 ± 0.3mg/dL, P < 0.001) and lower estimated glomerular filtration rate (54 ± 10 versus 57 ± 7mL/minute/1.73m2, P = 0.03) compared with patients who did not develop AKI. Patients who developed AKI were also more likely to be admitted to the intensive care unit, have surgical procedures, have hypotension and be prescribed loop diuretics. The presence of chronic kidney disease and hypotension were risk factors associated with AKI development. In addition, the AKI group had a significantly longer length of stay (14 days versus 8 days, P < 0.0001) and had a higher rate of all-cause hospital mortality (9% versus 1%, P = 0.03).


CONCLUSIONS
Patients with chronic kidney disease, hypotension and those undergoing surgeries were more likely to develop AKI while receiving RAS blockers. During hospitalization, temporary discontinuation of these medications may be warranted in patients with these characteristics.
Pharmaceutical Care Department, King Abdulaziz Medical City, Dammam, Saudi Arabia; Pharmacy Practice Department, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
Numan
N
Alabdan
Section of Nephrology, Stratton VA Medical Center, Albany, NY; Department of Medicine, Albany Medical College, Albany, NY.
Elvira O
EO
Gosmanova
Department of Preventive Medicine, The University of Tennessee Health Science Center, Memphis, TN.
Nhu Quynh T
NQ
Tran
Department of Clinical Pharmacy, Methodist University Hospital, Memphis, TN; Department of Clinical Pharmacy, The University of Tennessee Health Science Center, Memphis, TN.
Carrie S
CS
Oliphant
Department of Preventive Medicine, The University of Tennessee Health Science Center, Memphis, TN.
Hu
H
Pan
Department of Clinical Pharmacy, Methodist University Hospital, Memphis, TN; Department of Clinical Pharmacy, The University of Tennessee Health Science Center, Memphis, TN.
Joyce E
JE
Broyles
Department of Clinical Pharmacy, The University of Tennessee Health Science Center, Memphis, TN; Department of Medicine (Nephrology), The University of Tennessee Health Science Center, Memphis, TN. Electronic address: jhudson@uthsc.edu.
Joanna Q
JQ
Hudson
D058186:Acute Kidney Injury / Q000097:blood / Q000209:etiology* / Q000503:physiopathology; D000368:Aged; D000369:Aged, 80 and over; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D015897:Comorbidity; D003404:Creatinine / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007022:Hypotension / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology
D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D003404:Creatinine
Acute kidney injury; Angiotensin receptor antagonists; Angiotensin-converting enzyme inhibitors; Inpatient; Risk factors