Association between exposure to angiotensin-converting enzyme inhibitors and angiotensin receptor blockers prior to septic shock and acute kidney injury.
OBJECTIVE
To evaluate the association between angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) use prior to a septic shock episode and the development, prognosis and long-term recovery from acute kidney injury (AKI).


METHODS
A single-centre, prospective observational study was carried out between September 2005 and August 2010.


METHODS
Patients admitted to the ICU of a third level hospital.


METHODS
A total of 386 septic shock patients were studied.


METHODS
None.


METHODS
Use of ACEIs/ARBs, AKI development, recovery of previous creatinine levels and time to recovery.


RESULTS
A total of 386 patients were included, of which 312 (80.8%) developed AKI during ICU stay and 23% were receiving ACEIs/ARBs. The percentage of patients on ACEIs/ARBs increased significantly in relation to more severe stages of AKI irrespective of the kind of AKI score. After adjusting for confounders, the development of AKI was independently associated to the use of ACEIs/ARBs (OR 2.19; 95%CI 1.21-3.84; p=.04). With respect to the recovery of kidney function, the group of patients on ACEIs/ARBs had significantly higher creatinine levels at ICU discharge and needed hemodialysis more frequently thereafter. However, use of ACEIs/ARBs affected neither recovery of previous creatinine levels nor significantly delayed recovery.


CONCLUSIONS
The use of ACEIs/ARBs before septic shock episodes was correlated to AKI development and severity, but did not affect the recovery of kidney function after sepsis resolution.
Intensive Care Department, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain. Electronic address: bsuberviola@yahoo.es.
B
B
Suberviola
Department of Nephrology, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain.
E
E
Rodrigo
Intensive Care Department, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain.
A
A
González-Castro
Department of Nephrology, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain.
M
M
Serrano
Department of Nephrology, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain.
M
M
Heras
Intensive Care Department, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain.
Á
Á
Castellanos-Ortega
D058186:Acute Kidney Injury / Q000209:etiology*; D000368:Aged; D057911:Angiotensin Receptor Antagonists / Q000009:adverse effects*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012772:Shock, Septic / Q000150:complications*
D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors
Acute kidney injury; Angiotensin receptor blockers; Angiotensin-converting enzyme inhibitors; Fracaso renal agudo; Inhibidores de la enzima conversora de la angiotensina; Receptores de la angiotensina 2; Recovery; Recuperación; Septic shock; Shock séptico