ArticleBrazilian journal of anesthesiology (Elsevier)
Preoperative angiotensin-converting enzyme inhibitor or angiotensin receptor blocker use and acute kidney injury after high-risk cardiac surgery: a multicenter prospective cohort study.
Article in Brazilian journal of anesthesiology (Elsevier). The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe impact of preoperative Angiotensin-Converting Enzyme Inhibitors or Angiotensin Receptor Blockers (ACEI/ARB) on cardiac surgery-associated Acute Kidney Injury (AKI) remains elusive. We sought to evaluate the association of ACEI/ARB use with stage 2 or 3 AKI and in-hospital mortality, while evaluating whether preoperative withholding versus continuation strategies modulate clinical outcomes.
methodsMulticenter prospective cohort study involving 14 Spanish and British hospitals. The study population comprised high-risk cardiac surgery patients (Cleveland Clinic Score ≥ 4).
resultsAmong 249 patients (mean age: 69.5 years; 39% women; 53.8% ACEI/ARB users), the overall incidence of stage 2 or 3 AKI was 32.9%. ACEI/ARB use was associated with a significantly higher likelihood of stage 2 to 3 AKI (38.8% vs. 26.1%; adjusted OR = 2.79; 95% CI 1.47-5.30; p = 0.002). The adjusted risk difference was 0.188 (95% CI 0.079-0.298; p = 0.001), yielding a number needed to harm of 5.3. Sensitivity analyses confirmed the robustness of these findings, with an E-value of 2.73 (lower limit: 1.72) and consistent results using augmented inverse probability weighting (average treatment effect: 0.191; 95% CI 0.081-0.300; p = 0.001). No statistically significant associations were observed in in-hospital mortality or the impact of preoperative withholding versus continuation strategies on clinical outcomes.
conclusionThis study suggests preoperative ACEI/ARB use may be associated with an increased incidence of stage 2 or 3 AKI. While differences in in-hospital mortality and preoperative withholding versus continuation strategies did not reach statistical significance, these findings reveal clinical trends that warrant further investigation.
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