Evidence map›Paper›PMID 32723383›Full record

ArticleBMC medicine2020

Stopping renin-angiotensin system blockers after acute kidney injury and risk of adverse outcomes: parallel population-based cohort studies in English and Swedish routine care.

Patrick Bidulka, Edouard L Fu, Clémence Leyrat, Fotini Kalogirou, Katherine S L McAllister, Edward J Kingdon, Kathryn E Mansfield, Masao Iwagami, Liam Smeeth, Catherine M Clase and 5 more

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMC medicine, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 33 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
33citing papers in PubMed, 2 pooled it
3.2field-weighted citation impact, top 7% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

33 citing papers in PubMed, 2 syntheses or guidelines pooled it, 43 citations in OpenAlex.

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  16. Role of G protein coupled receptors in acute kidney injury.Cell communication and signaling : CCS · 2024
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors at 7 institutions in 5 countries.

Patrick BidulkaDepartment of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. patrick.bidulka1@lshtm.ac.uk.ORCID 0000-0001-7644-2030
Edouard L FuDepartment of Clinical Epidemiology, Leiden University Medical Center, Albinusdreef, Leiden, 2333ZA, The Netherlands.
Clémence LeyratDepartment of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
Fotini KalogirouCambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK.
Katherine S L McAllisterDepartment of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
Edward J KingdonSussex Kidney Unit, Royal Sussex County Hospital, Brighton, BN2 5BE, UK.
Kathryn E MansfieldDepartment of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
Masao IwagamiDepartment of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.
Liam SmeethDepartment of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
Catherine M ClaseDepartment of Medicine, Department of Health Research, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
Krishnan BhaskaranDepartment of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
Merel van DiepenDepartment of Clinical Epidemiology, Leiden University Medical Center, Albinusdreef, Leiden, 2333ZA, The Netherlands.
Juan-Jesus CarreroDepartment of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12, Stockholm, Sweden.
Dorothea NitschDepartment of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
Laurie A TomlinsonDepartment of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
University of London · GBLeiden University Medical Center · NLCambridge University Hospitals NHS Foundation Trust · GBImpact · CAKarolinska Institutet · SERoyal Sussex County Hospital · GBUniversity of Tsukuba · JP

Funding

Medical Research Council MR/T032448/1Vetenskapsrådet 2019-01059Wellcome Trust 101143/Z/13/ZWellcome Trust 107731/Z/15/Z
6 · The paper itself

Abstract

backgroundThe safety of restarting angiotensin-converting enzyme inhibitors (ACEI) or angiotensin II receptor blockers (ARB) after acute kidney injury (AKI) is unclear. There is concern that previous users do not restart ACEI/ARB despite ongoing indications. We sought to determine the risk of adverse events after an episode of AKI, comparing prior ACEI/ARB users who stop treatment to those who continue.

methodsWe conducted two parallel cohort studies in English and Swedish primary and secondary care, 2006-2016. We used multivariable Cox regression to estimate hazard ratios (HR) for hospital admission with heart failure (primary analysis), AKI, stroke, or death within 2 years after hospital discharge following a first AKI episode. We compared risks of admission between people who stopped ACEI/ARB treatment to those who were prescribed ACEI/ARB within 30 days of AKI discharge. We undertook sensitivity analyses, including propensity score-matched samples, to explore the robustness of our results.

resultsIn England, we included 7303 people with AKI hospitalisation following recent ACEI/ARB therapy for the primary analysis. Four thousand three (55%) were classified as stopping ACEI/ARB based on no prescription within 30 days of discharge. In Sweden, we included 1790 people, of whom 1235 (69%) stopped treatment. In England, no differences were seen in subsequent risk of heart failure (HR 1.10; 95% confidence intervals (CI) 0.93-1.30), AKI (HR 0.90; 95% CI 0.77-1.05), or stroke (HR 0.99; 95% CI 0.71-1.38), but there was an increased risk of death (HR 1.27; 95% CI 1.15-1.41) in those who stopped ACEI/ARB compared to those who continued. Results were similar in Sweden: no differences were seen in risk of heart failure (HR 0.91; 95% CI 0.73-1.13) or AKI (HR 0.81; 95% CI 0.54-1.21). However, no increased risk of death was seen (HR 0.94; 95% CI 0.78-1.13) and stroke was less common in people who stopped ACEI/ARB (HR 0.56; 95% CI 0.34-0.93). Results were similar across all sensitivity analyses.

conclusionsPrevious ACEI/ARB users who continued treatment after an episode of AKI did not have an increased risk of heart failure or subsequent AKI compared to those who stopped the drugs.

Indexed as

Acute Kidney InjuryAdolescentAdultAgedAged, 80 and overAngiotensin-Converting Enzyme InhibitorsAngiotensin Receptor AntagonistsCohort StudiesFemaleHumansMaleMiddle AgedProportional Hazards ModelsSwedenUnited KingdomYoung AdultAngiotensin-Converting Enzyme InhibitorsAngiotensin Receptor AntagonistsAcute kidney injuryAngiotensin-converting enzyme inhibitor (ACEI)Angiotensin II receptor blocker (ARB)Heart failure

Identifiers

PMID32723383
PMCPMC7389346
OpenAlexW3046192929

What OpenQuestion holds

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LicenceCC BY
Read underepoch 390

Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.