title: What are the risks and benefits of temporarily discontinuing medications to prevent acute kidney injury? A systematic review and meta-analysis.
abstract: To summarise evidence on temporary discontinuation of medications to prevent acute kidney injury (AKI).
  
  
  
  Systematic review and meta-analysis of randomised and non-randomised studies.
  
  
  
  Adults taking diuretics, ACE inhibitors (ACEI), angiotensin receptor blockers (ARB), direct renin inhibitors, non-steroidal anti-inflammatories, metformin or sulfonylureas, experiencing intercurrent illnesses, radiological or surgical procedures.
  
  
  
  Temporary discontinuation of any of the medications of interest.
  
  
  
  Risk of AKI. Secondary outcome measures were estimated glomerular filtration rate and creatinine post-AKI, urea, systolic and diastolic blood pressure, death, clinical outcomes and biomarkers.
  
  
  
  6 studies were included (1663 participants), 3 randomised controlled trials (RCTs) and 3 prospective cohort studies. The mean age ranged from 65 to 73 years, and the proportion of women ranged from 31% to 52%. All studies were in hospital settings; 5 evaluated discontinuation of medication prior to coronary angiography and 1 prior to cardiac surgery. 5 studies evaluated discontinuation of ACEI and ARBs and 1 small cohort study looked at discontinuation of non-steroidal anti-inflammatory drugs. No studies evaluated discontinuation of medication in the community following an acute intercurrent illness. There was an increased risk of AKI of around 15% in those in whom medication was continued compared with those in whom it was discontinued (relative risk (RR) 1.17, 95% CI 0.99 to 1.38; 5 studies). When only results from RCTs were pooled, the increase in risk was almost 50% (RR 1.48, 95% CI 0.84 to 2.60; 3 RCTs), but the CI was wider. There was no difference between groups for any secondary outcomes.
  
  
  
  There is low-quality evidence that withdrawal of ACEI/ARBs prior to coronary angiography and cardiac surgery may reduce the incidence of AKI. There is no evidence of the impact of drug cessation interventions on AKI incidence during intercurrent illness in primary or secondary care.
  
  
  
  PROSPERO CRD42015023210.
authors.affiliation: The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK.|School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: Penny
authors.initials: P
authors.lastname: Whiting
authors.affiliation: The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK.|School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Morden
authors.affiliation: UK Renal Registry, Bristol, UK.|Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Laurie A
authors.initials: LA
authors.lastname: Tomlinson
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, UK.|UK Renal Registry, Bristol, UK.
authors.forename: Fergus
authors.initials: F
authors.lastname: Caskey
authors.affiliation: Centre for Primary Care, Institute of Population Health, The University of Manchester, Manchester, UK.|National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Greater Manchester, Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, UK.
authors.forename: Thomas
authors.initials: T
authors.lastname: Blakeman
authors.affiliation: Department of Renal Medicine, Freeman Hospital, Newcastle Upon Tyne Hospitals Foundation Trust, Tyne and Wear, UK.
authors.forename: Charles
authors.initials: C
authors.lastname: Tomson
authors.affiliation: The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK.|School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: Tracey
authors.initials: T
authors.lastname: Stone
authors.affiliation: The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK.|School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: Alison
authors.initials: A
authors.lastname: Richards
authors.affiliation: The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK.|School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: Jelena
authors.initials: J
authors.lastname: Savović
authors.affiliation: The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK.|School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Horwood
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000139:chemically induced / Q000517:prevention & control*; D057911:Angiotensin Receptor Antagonists / Q000008:administration & dosage* / Q000009:adverse effects; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage* / Q000009:adverse effects; D003404:Creatinine / Q000097:blood; D000069340:Deprescriptions; D004232:Diuretics / Q000008:administration & dosage* / Q000009:adverse effects; D005919:Glomerular Filtration Rate; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D008687:Metformin / Q000008:administration & dosage / Q000009:adverse effects; D018570:Risk Assessment; D013453:Sulfonylurea Compounds / Q000008:administration & dosage / Q000009:adverse effects; D000092502:Renin Inhibitors
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000894:Anti-Inflammatory Agents, Non-Steroidal; D003404:Creatinine; D004232:Diuretics; D007004:Hypoglycemic Agents; D008687:Metformin; D013453:Sulfonylurea Compounds; D000092502:Renin Inhibitors
keywords: Acute kidney injury; Angiotensin receptor blockers; Angiotensin-converting enzyme inhibitors; Medication discontinuation; NSAIDs; Sick day rules