title: Renin-Angiotensin System Inhibitor is Associated with Lower Risk of Ensuing Chronic Kidney Disease after Functional Recovery from Acute Kidney Injury.
abstract: Acute kidney injury (AKI) is an independent risk factor for ensuing chronic kidney disease (CKD). Animal studies have demonstrated that renin-angiotensin system (RAS) inhibitor can reduce ensuing CKD after functional recovery from AKI. Here we study the association between ensuing CKD and use of RAS inhibitor including angiotensin converting enzyme inhibitor or angiotensin II type 1a receptor blocker starting after renal functional recovery in our prospectively collected observational AKI cohort. Adult patients who had cardiac surgery-associated AKI (CSA-AKI) are studied. Patients with CKD, unrecovered AKI, and use of RAS inhibitor before surgery are excluded. Among 587 eligible patients, 94 patients are users of RAS inhibitor which is started and continued after complete renal recovery during median follow-up period of 2.99 years. The users of RAS inhibitor show significantly lower rate of ensuing CKD (users vs. non-users, 26.6% vs. 42.2%) and longer median CKD-free survival time (users vs. non-users, 1079 days vs. 520 days). Multivariate Cox regression analyses further demonstrate that use of RAS inhibitor is independently associated with lower risk of ensuing CKD (hazard ratio = 0.46, P < 0.001). We conclude that use of RAS inhibitor in CSA-AKI patients after renal functional recovery is associated with lower risk of ensuing CKD development.
authors.affiliation: Renal Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.|Department of Internal Medicine, National Taiwan University Hospital Jin-Shan Branch, New Taipei City, Taiwan.|Graduate Institute of Physiology, College of Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Yu-Hsiang
authors.initials: YH
authors.lastname: Chou
authors.affiliation: Renal Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Tao-Min
authors.initials: TM
authors.lastname: Huang
authors.affiliation: Renal Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.|Graduate Institute of Physiology, College of Medicine, National Taiwan University, Taipei, Taiwan.|Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
authors.forename: Szu-Yu
authors.initials: SY
authors.lastname: Pan
authors.affiliation: Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Chin-Hao
authors.initials: CH
authors.lastname: Chang
authors.affiliation: Renal Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Chun-Fu
authors.initials: CF
authors.lastname: Lai
authors.affiliation: Renal Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Vin-Cent
authors.initials: VC
authors.lastname: Wu
authors.affiliation: Renal Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Ming-Shiou
authors.initials: MS
authors.lastname: Wu
authors.affiliation: Renal Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Kwan-Dun
authors.initials: KD
authors.lastname: Wu
authors.affiliation: Renal Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Tzong-Shinn
authors.initials: TS
authors.lastname: Chu
authors.affiliation: Renal Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.|Graduate Institute of Physiology, College of Medicine, National Taiwan University, Taipei, Taiwan.|Department of Integrated Diagnostics &Therapeutics, National Taiwan University Hospital, Taipei, Taiwan.|Research Center for Developmental Biology and Regenerative Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Shuei-Liong
authors.initials: SL
authors.lastname: Lin
mesh_terms: D058186:Acute Kidney Injury / Q000150:complications / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology; D000328:Adult; D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000008:administration & dosage*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000517:prevention & control; D012084:Renin-Angiotensin System; D015996:Survival Rate
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors