Halting renin-angiotensin system (RAS) inhibitors in patients with acute kidney injury (AKI) may decrease the risk for hyperkalemia, but patients will miss out on the benefits of these drugs, according to a presentation at the European Renal Association 2022 annual meeting.
In the Stockholm CREAtinine Measurements (SCREAM) project, 10,165 users of RAS inhibitors experienced stage 2-3 or clinically recognized AKI during hospitalization. Within 3 months of discharge, 4429 (44%) stopped angiotensin-converting-enzyme inhibitors or angiotensin receptor blockers, whereas 5736 (56%) continued these antihypertensive drugs.
In adjusted analyses, the risk for the composite outcome of all-cause mortality and cardiovascular events (ie, myocardial infarction and stroke) increased by 13% among those who stopped RAS inhibitors, Roemer J Janse, a master’s degree student at Leiden University Medical Center in The Netherlands, and colleagues reported at the meeting and in the Clinical Kidney Journal. The risk for hyperkalemia (serum potassium 5.5 mmol/L or higher) significantly decreased by 21% in this group. The risks for recurrent AKI, heart failure hospitalization, and chronic kidney disease progression did not differ between those stopping and continuing these drugs.
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Patients with a baseline kidney function of less than 15 mL/min/1.73 m2, those on dialysis, and kidney transplant recipients were excluded from the study.
According to the investigators, the majority of observational evidence to date, including this study, supports continued RAS inhibitor use in this population at high cardiovascular risk, “on the basis of consistent associations with decreased cardiovascular events and death, and uncertain, variable effects on recurrent AKI.” These findings may aid physicians in their clinical decision-making in the absence of randomized clinical trial data.
Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Reference
Janse RJ, Fu EL, Clase CM, et al. Stopping versus continuing renin-angiotensin system inhibitors after acute kidney injury and adverse clinical outcomes: an observational study from routine care data. Presented at: ERA 59th Congress, May 19-22, 2022. Abstract FC 129.
Janse RJ, Fu EL, Clase CM, et al. Stopping versus continuing renin-angiotensin-system inhibitors after acute kidney injury and adverse clinical outcomes: an observational study from routine care data. Clin Kidney J. June 2022:1109-1119. doi:10.1093/ckj/sfac003
