Users of renin angiotensin aldosterone system inhibitors (RAASi) or diuretics have a slightly increased risk of acute kidney injury (AKI), new study findings in BMC Nephrology confirm. 

In multivariate and propensity-score-adjusted analyses of data from nearly 150,000 individuals in the United Kingdom’s Clinical Practice Research Datalink (2008–2015), first-time users of RAASi or diuretics had a 23% and 24% increased risk for AKI, respectively. A prior event rate ratio analysis, which additionally adjusts for unmeasured confounding, yielded a similar hazard ratio of 29%.

Only individuals taking 2 or more antihypertensive drugs were at risk for AKI, Jemima Scott, BM, BCh, of the University of Bristol in Bristol, UK, and collaborators reported. Absolute AKI risk was small: 2.5 vs 1.7 events per 1000 person years in patients users and non-users of RAASis/diuretics, respectively.

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“The risk of AKI associated with RAAS inhibition must be weighed against the potential benefits for each individual, including delayed progression of CKD, reduction in cardiovascular events (myocardial infarction, cerebrovascular events, resistant heart failure following myocardial infarction) and mortality (all-cause and cardiovascular-specific),” Dr Scott’s team stated. “The risk-benefit ratio is likely to be influenced by level of comorbidity as well as concurrent medications.”

AKI risk increases with the number of additional hypertensive medications and diuretics, the investigators noted. Such medications might reduce the effective circulating volume in the kidneys, they suggested.

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Scott J, Jones T, Redaniel MT, et al. Estimating the risk of acute kidney injury associated with use of diuretics and renin angiotensin aldosterone system inhibitors: A population based cohort study using the clinical practice research datalink [published online December 30, 2019]. BMC Nephrol. 2019;20:481. doi: 10.1186/s12882-019-1633-2