Up to 15% of the increase in hospital admission rates in England for acute kidney injury (AKI) over a four-year period was potentially attributable to more prescribing of ACE inhibitors and angiotensin-receptor antagonists (ARAs), Laurie A. Tomlinson, PhD, of the University of Cambridge in the U.K., and associates reported in PLOS ONE (2013;8[11]:e78465).

The ecological analysis of prescribing data from England’s National Health Service revealed that from 2007-2008 to 2010-2011, crude admission rates for AKI rose 51.6%, from 0.38 to 0.57 per 1,000 patients. During that time, national annual ACE inhibitor/ARA prescribing rates increased by 15.8%, from 0.202 to 0.234.

“Better understanding of individual level risk factors for AKI associated with ACE inhibitors and ARAs are needed to reduce the potential harms associated with these important and commonly prescribed medications,” the authors concluded. “This ecological analysis demonstrates that the national increases in prescribing may be a powerful driver of increased AKI incidence, and throws uncertainty on the balance of benefits and risks associated with use of these drugs.”

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According to Dr. Tomlinson’s group, strong evidence indicated that the increased prescribing of those drugs was linked with the increase in AKI admission rates. Other studies, too, have demonstrated an increasing incidence of AKI and evidence that AKI can result from treatment with ACE inhibitors and ARAs, usually in the presence of intercurrent illness. “However, [this] is the first study to quantify the extent to which the changing incidence of AKI may be due to these medications,” the researchers wrote.

As Dr. Tomlinson’s team pointed out, examining the association between AKI and treatment with ACE inhibitors and ARAs is difficult because both the drugs and the reasons for prescribing them are risk factors for AKI. The findings in this study were limited by the lack of patient-level data such as indication for prescribing and patient characteristics.