Renin-Angiotensin-Aldosterone System Blockade in Critically Ill Patients Is Associated with Increased Risk for Acute Kidney Injury

Renin-Angiotensin-Aldosterone System Blockade in Critically Ill Patients Is Associated with Increased Risk for Acute Kidney Injury

HYE JIN LIM,¹ HYUN HEE LEE,^1,2 AE JIN KIM,¹ HAN RO,^1,2 HYUNG SOO KIM,¹ JAE HYUN CHANG,^1,2 WOOKYUNG CHUNG^1,2 and JI YONG JUNG^1,2

¹Division of Nephrology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
²Division of Nephrology, Department of Internal Medicine, Gachon University School of Medicine, Incheon, Korea

Acute kidney injury (AKI) is a major clinical problem and a predictor of outcomes in critically ill patients who frequently required treatments in the intensive care unit (ICU). Renin-angiotensin-aldosterone system (RAAS) blockers are commonly used for treating hypertension but demands caution because of accompanying illnesses including AKI. The aim of this study was to evaluate whether the use of RAAS blockers affected the incidence of AKI in ICU patients. From a total of 26,287 patients who were admitted to the ICU from January 2003 to December 2013 were included in the final analyses. The primary outcome was the incidence of AKI based on the prescription of RAAS blockers. The secondary outcomes were all-cause mortality. RAAS blocker users were more likely to develop AKI (P < 0.001) and remained an independent risk factor for AKI (odds ratio [OR], 1.56; 95% confidence interval [CI], 1.37-1.79; P < 0.001) after adjusting confounding factors. There was no significant difference in the cumulative 90-day survival rate between the RAAS blocker users and non-users (P = 0.381). However, the adjusted mortality risk associated with AKI was 1.38 (95% CI, 1.22 to 1.56; P < 0.001) and increased as the severity of AKI stage increased from 1 to 3: 1.17 (1.02 to 1.36), 1.77 (1.45 to 2.16), and 1.93 (1.55 to 2.41; P < 0.01 for the trend). RAAS blockers may have a harmful influence to increase the incidence of AKI and temporary withholding of these medications may deserve careful consideration in ICU patients.

keywords —— acute kidney injury; intensive care unit; mortality; outcomes; renin-angiotensin-aldosterone system blocker

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Tohoku J. Exp. Med., 2016, 238, 17-23

Correspondence: Ji Yong Jung, M.D., Ph.D., Division of Nephrology, Department of Internal Medicine, Gachon University Gil Medical Center, 21 Namdong-daero 774 beon-gil, Namdong-gu, Incheon 21565, Republic of Korea. Division of Nephrology, Department of Internal Medicine, Gachon University School of Medicine, 38 Dokjeom-ro 3 beon-gil, Namdong-gu, Incheon 21565, Republic of Korea.

e-mail: jyjung@gachon.ac.kr