WASHINGTON—Preoperative use of angiotensin receptor blockers (ARBs) may increase the risk of postoperative acute kidney injury (AKI), according to study findings presented at the American Society of Nephrology’s 2019 Kidney Week conference.
In a retrospective study of 28,418 adult patients who underwent 42,047 abdominal, cardiothoracic, vascular, or orthopedic surgeries, investigators in Iceland found that ARB use prior to surgery was significantly associated with 30% greater odds of postoperative AKI compared with nonuse. However, preoperative use of a proton pump inhibitor (PPI), ACE inhibitor, or aldosterone antagonist (AA) was not associated with increased postoperative AKI risk, reported in a poster presentation by Thorir E. Long, MD, a doctoral candidate at the University of Iceland in Reykjavik, and colleagues.
Of the 19,279 patients for whom pre- and postoperative serum creatinine measurements were available for detecting AKI, postoperative AKI occurred in 1455 (7.5%). Results showed that 6568 (34%) of these patients had used a PPI prior to surgery, and postoperative AKI developed in 547 (8.3%) of them. Of 6717 patients (35%) who used an ACE inhibitor, ARB, or AA before surgery, AKI developed in 724 (10.8%). The investigators considered patients to be using a medication if they had filled a prescription within 6 months prior to surgery. The investigators defined AKI according to Kidney Disease: Improving Global Outcomes (KDIGO) criteria.
“While this retrospective associational study cannot prove association, these preliminary results suggest that the use of certain medications may be a modifiable risk factor for post-operative AKI, and this relationship warrants further study,” Dr Long told Renal & Urology News.
Long TE, Helgason D, Palsson R, et al. Preoperative medication use and development of postoperative AKI. Presented at the American Society of Nephrology’s 2019 Kidney Week meeting held November 5 to 10 in Washington, DC. Abstract FR-PO019.