Among older adults with a history of myocardial infarction, those who experience acute kidney injury (AKI) are less likely to receive prescriptions for 3 vital cardiovascular drugs within a year of hospital discharge, according to a recent study.
Investigators matched and compared 21,452 patients with AKI and 21,452 patients without AKI from Canada who had a history of myocardial infarction. Of these, 34% had a myocardial infarction during the index hospitalization. The patients had a mean age of 80 years, and 40% were female.
Experiencing any AKI was significantly associated with a 7% lower likelihood of receiving an angiotensin-converting enzyme inhibitor (ACEi)/angiotensin II receptor blocker (ARB), statin, or β-blocker within 1 year of hospital discharge, Samuel A. Silver, MD, MSc, of Queen’s University in Kingston, Ontario, Canada, and colleagues reported in Kidney International Reports. KDIGO stage 2 and 3 AKI were significantly associated with a 19% and 29% lower likelihood of receiving these 3 cardiovascular drugs, respectively, compared with no AKI.
“The foremost driver of this finding was the less frequent dispensing of ACEi/ARBs, even in patients with KDIGO stage 1 AKI,” Dr Silver’s team reported. An ACEi/ARB prescription was 10%, 23%, and 35% less likely for patients with AKI stage 1, 2, and 3, respectively, compared with no AKI. A statin prescription was 13% and 15% less likely for patients with stage 2 and stage 3 AKI, respectively. A β-blocker prescription was 14% less likely for patients with stage 3 AKI.
The investigators suggested that underuse of ACEi/ARBs may be due to fears of worsening kidney function. Underuse of β-blockers and statins may relate to concerns over hemodynamic instability or toxicity from low kidney function.
“Although there may be some legitimate safety concerns with ACEi/ARBs in a small number of patients post-AKI, these kidney-related anxieties should not extend to patients with evidence-based indications for β-blockers or statins,” Dr Silver’s team wrote.
AKI also was significantly associated with 5% and 6% lower dispensing of P2Y12 inhibitors and direct anticoagulants, respectively, but 16% higher dispensing of warfarin. Dispensing of thiazides and dihydropyridine calcium channel blockers were 7% and 11% lower with AKI, respectively. Dispensing of biguanides and nonsteroidal anti-inflammatory inhibitors were 12% and 11% lower with AKI, respectively.
Prescription of loop diuretics and mineralocorticoid receptor antagonists were a significant 20% and 22% higher with AKI, respectively.
Delays in the use of these cardiovascular drugs in patients with a history of myocardial infarction have been linked with increased risks of hospitalizations and death, the investigators noted.
These study results highlight a “pivotal opportunity” to improve care after hospitalization with AKI, according to Dr Silver’s team.
Meraz-Muñoz AY, Jeyakumar N, Luo B, et al. Cardiovascular drug use after acute kidney injury among hospitalized patients with a history of myocardial infarction. Kidney Int Rep. Published online November 2, 2022. doi:10.1016/j.ekir.2022.10.027