Continuation of Renin-Angiotensin-Aldosterone Inhibitors Does Not Impact Renal Function Among Patients Undergoing Percutaneous Nephrolithotomy.
In the perioperative period, renin-angiotensin-aldosterone system (RAAS) inhibitors may result in cardiovascular and renal functional changes. We sought to determine the acute and chronic renal functional and blood pressure effects of continuing or withdrawing angiotensin-converting enzyme inhibitors (ACE-I) and angiotensin receptor blockers (ARBs) after percutaneous nephrolithotomy (PCNL).



This was a retrospective review of all patients undergoing PCNL at our institution from 2002 to 2013. Patients on either an ACE-I and/or ARB who received an ACE-I and/or ARB during their surgical hospitalization were matched based on sex, age, and body mass index to patients who had their medication withheld during the postoperative period. The two groups were compared.



A total of 2784 patients underwent PCNL during the study period. At the time of PCNL, 15.2% (423/2784) of patients and 6.5% (181/2784) were prescribed an ACE-I and an ARB, respectively. Fifty-nine percent (248/423) of patients on an ACE-I and 66.9% (121/181) on an ARB received their medication during their postoperative hospitalization. There was no significant difference in average length of stay (2 days vs 2 days), perioperative change in glomerular filtration rate, glomerular filtration rate (GFR) (-0.50 mL/min/1.73 m2vs -2.34 mL/min/1.73 m2, p = 0.267), change in GFR at 1 month postoperatively (-4.63 mL/min/1.73 m2vs -5.90 mL/min/1.73 m2, p = 0.748), or change in GFR at 1 year (-2.08 mL/min/1.73 m2vs -0.13 mL/min/1.73 m2, p = 0.267) between patients who received vs withheld their medication during the postoperative stay.



It is safe to continue RAAS inhibitors in patients undergoing PCNL during their operative hospitalization.
Department of Urology, Glickman Urological and Kidney Institute , Cleveland Clinic Foundation, Cleveland, Ohio.
Nishant
N
Patel
Department of Urology, Glickman Urological and Kidney Institute , Cleveland Clinic Foundation, Cleveland, Ohio.
Benjamin R
BR
Cohen
Department of Urology, Glickman Urological and Kidney Institute , Cleveland Clinic Foundation, Cleveland, Ohio.
Shubha
S
De
Department of Urology, Glickman Urological and Kidney Institute , Cleveland Clinic Foundation, Cleveland, Ohio.
Ganesh
G
Kartha
Department of Urology, Glickman Urological and Kidney Institute , Cleveland Clinic Foundation, Cleveland, Ohio.
Ina
I
Li
Department of Urology, Glickman Urological and Kidney Institute , Cleveland Clinic Foundation, Cleveland, Ohio.
Carl
C
Sarkissian
Department of Urology, Glickman Urological and Kidney Institute , Cleveland Clinic Foundation, Cleveland, Ohio.
Juan
J
Calle
Department of Urology, Glickman Urological and Kidney Institute , Cleveland Clinic Foundation, Cleveland, Ohio.
Manoj
M
Monga
D000368:Aged; D057911:Angiotensin Receptor Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007669:Kidney Calculi / Q000188:drug therapy / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D000074642:Nephrolithotomy, Percutaneous; D059035:Perioperative Period; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies
D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors
acute kidney injury; angiotensin receptor blocker; angiotensin-converting enzyme inhibitor; percutaneous nephrolithotomy