Preoperative angiotensin-converting enzyme inhibitors and angiotensin receptor blocker use and acute kidney injury in patients undergoing cardiac surgery

Steven G. Coca, Amit X. Garg, Madhav Swaminathan, Susan Garwood, Kwangik Hong, Heather Thiessen Philbrook, Cary Passik, Jay L. Koyner, Chirag Parikh

Research output: Contribution to journalArticle

Abstract

Background. Using either an angiotensin-converting enzyme inhibitor (ACEi) or an angiotensin receptor blocker (ARB) the morning of surgery may lead to 'functional' postoperative acute kidney injury (AKI), measured by an abrupt increase in serum creatinine.Whether the same is true for 'structural' AKI, measured with new urinary biomarkers, is unknown. Methods. The TRIBE-AKI study was a prospective cohort study of 1594 adults undergoing cardiac surgery at six hospitals between July 2007 and December 2010. We classified the degree of exposure to ACEi/ARB into three categories: 'none' (no exposure prior to surgery), 'held' (on chronic ACEi/ARB but held on the morning of surgery) or 'continued' (on chronic ACEi/ARB and taken the morning of surgery). The co-primary outcomes were 'functional' AKI based upon changes in pre- to postoperative serum creatinine, and 'structural AKI', based upon peak postoperative levels of four urinary biomarkers of kidney injury. Results. Across the three levels (none, held and continued) of ACEi/ARB exposure there was a graded increase in functional AKI, as defined by AKI stage 1 or worse; (31, 34 and 42%, P for trend 0.03) and by percentage change in serum creatinine from pre- to postoperative (25, 26 and 30%, P for trend 0.03). In contrast, there were no differences in structural AKI across the strata of ACEi/ARB exposure, as assessed by four structural AKI biomarkers (neutrophil gelatinase-associated lipocalin, kidney injury molecule-1, interleukin-18 or liver-fatty acid-binding protein). Conclusions. Preoperative ACEi/ARB usage was associated with functional but not structural acute kidney injury. As AKI from ACEi/ARB in this setting is unclear, interventional studies testing different strategies of perioperative ACEi/ARB use are warranted.

Original languageEnglish (US)
Pages (from-to)2787-2799
Number of pages13
JournalNephrology Dialysis Transplantation
Volume28
Issue number11
DOIs
StatePublished - Nov 1 2013

Fingerprint

Angiotensin Receptor Antagonists
Angiotensin-Converting Enzyme Inhibitors
Acute Kidney Injury
Thoracic Surgery
Creatinine
Biomarkers
Serum
Kidney
Fatty Acid-Binding Proteins
Interleukin-18
Wounds and Injuries
Cohort Studies
Prospective Studies

Keywords

  • Acute renal failure
  • Biomarkers
  • Serum creatinine

ASJC Scopus subject areas

  • Nephrology
  • Transplantation

Cite this

Preoperative angiotensin-converting enzyme inhibitors and angiotensin receptor blocker use and acute kidney injury in patients undergoing cardiac surgery. / Coca, Steven G.; Garg, Amit X.; Swaminathan, Madhav; Garwood, Susan; Hong, Kwangik; Thiessen Philbrook, Heather; Passik, Cary; Koyner, Jay L.; Parikh, Chirag.

In: Nephrology Dialysis Transplantation, Vol. 28, No. 11, 01.11.2013, p. 2787-2799.

Research output: Contribution to journalArticle

Coca, Steven G. ; Garg, Amit X. ; Swaminathan, Madhav ; Garwood, Susan ; Hong, Kwangik ; Thiessen Philbrook, Heather ; Passik, Cary ; Koyner, Jay L. ; Parikh, Chirag. / Preoperative angiotensin-converting enzyme inhibitors and angiotensin receptor blocker use and acute kidney injury in patients undergoing cardiac surgery. In: Nephrology Dialysis Transplantation. 2013 ; Vol. 28, No. 11. pp. 2787-2799.
@article{0889881caf454cab85f159c9d15809db,
title = "Preoperative angiotensin-converting enzyme inhibitors and angiotensin receptor blocker use and acute kidney injury in patients undergoing cardiac surgery",
abstract = "Background. Using either an angiotensin-converting enzyme inhibitor (ACEi) or an angiotensin receptor blocker (ARB) the morning of surgery may lead to 'functional' postoperative acute kidney injury (AKI), measured by an abrupt increase in serum creatinine.Whether the same is true for 'structural' AKI, measured with new urinary biomarkers, is unknown. Methods. The TRIBE-AKI study was a prospective cohort study of 1594 adults undergoing cardiac surgery at six hospitals between July 2007 and December 2010. We classified the degree of exposure to ACEi/ARB into three categories: 'none' (no exposure prior to surgery), 'held' (on chronic ACEi/ARB but held on the morning of surgery) or 'continued' (on chronic ACEi/ARB and taken the morning of surgery). The co-primary outcomes were 'functional' AKI based upon changes in pre- to postoperative serum creatinine, and 'structural AKI', based upon peak postoperative levels of four urinary biomarkers of kidney injury. Results. Across the three levels (none, held and continued) of ACEi/ARB exposure there was a graded increase in functional AKI, as defined by AKI stage 1 or worse; (31, 34 and 42{\%}, P for trend 0.03) and by percentage change in serum creatinine from pre- to postoperative (25, 26 and 30{\%}, P for trend 0.03). In contrast, there were no differences in structural AKI across the strata of ACEi/ARB exposure, as assessed by four structural AKI biomarkers (neutrophil gelatinase-associated lipocalin, kidney injury molecule-1, interleukin-18 or liver-fatty acid-binding protein). Conclusions. Preoperative ACEi/ARB usage was associated with functional but not structural acute kidney injury. As AKI from ACEi/ARB in this setting is unclear, interventional studies testing different strategies of perioperative ACEi/ARB use are warranted.",
keywords = "Acute renal failure, Biomarkers, Serum creatinine",
author = "Coca, {Steven G.} and Garg, {Amit X.} and Madhav Swaminathan and Susan Garwood and Kwangik Hong and {Thiessen Philbrook}, Heather and Cary Passik and Koyner, {Jay L.} and Chirag Parikh",
year = "2013",
month = "11",
day = "1",
doi = "10.1093/ndt/gft405",
language = "English (US)",
volume = "28",
pages = "2787--2799",
journal = "Nephrology Dialysis Transplantation",
issn = "0931-0509",
publisher = "Oxford University Press",
number = "11",

}

TY - JOUR

T1 - Preoperative angiotensin-converting enzyme inhibitors and angiotensin receptor blocker use and acute kidney injury in patients undergoing cardiac surgery

AU - Coca, Steven G.

AU - Garg, Amit X.

AU - Swaminathan, Madhav

AU - Garwood, Susan

AU - Hong, Kwangik

AU - Thiessen Philbrook, Heather

AU - Passik, Cary

AU - Koyner, Jay L.

AU - Parikh, Chirag

PY - 2013/11/1

Y1 - 2013/11/1

N2 - Background. Using either an angiotensin-converting enzyme inhibitor (ACEi) or an angiotensin receptor blocker (ARB) the morning of surgery may lead to 'functional' postoperative acute kidney injury (AKI), measured by an abrupt increase in serum creatinine.Whether the same is true for 'structural' AKI, measured with new urinary biomarkers, is unknown. Methods. The TRIBE-AKI study was a prospective cohort study of 1594 adults undergoing cardiac surgery at six hospitals between July 2007 and December 2010. We classified the degree of exposure to ACEi/ARB into three categories: 'none' (no exposure prior to surgery), 'held' (on chronic ACEi/ARB but held on the morning of surgery) or 'continued' (on chronic ACEi/ARB and taken the morning of surgery). The co-primary outcomes were 'functional' AKI based upon changes in pre- to postoperative serum creatinine, and 'structural AKI', based upon peak postoperative levels of four urinary biomarkers of kidney injury. Results. Across the three levels (none, held and continued) of ACEi/ARB exposure there was a graded increase in functional AKI, as defined by AKI stage 1 or worse; (31, 34 and 42%, P for trend 0.03) and by percentage change in serum creatinine from pre- to postoperative (25, 26 and 30%, P for trend 0.03). In contrast, there were no differences in structural AKI across the strata of ACEi/ARB exposure, as assessed by four structural AKI biomarkers (neutrophil gelatinase-associated lipocalin, kidney injury molecule-1, interleukin-18 or liver-fatty acid-binding protein). Conclusions. Preoperative ACEi/ARB usage was associated with functional but not structural acute kidney injury. As AKI from ACEi/ARB in this setting is unclear, interventional studies testing different strategies of perioperative ACEi/ARB use are warranted.

AB - Background. Using either an angiotensin-converting enzyme inhibitor (ACEi) or an angiotensin receptor blocker (ARB) the morning of surgery may lead to 'functional' postoperative acute kidney injury (AKI), measured by an abrupt increase in serum creatinine.Whether the same is true for 'structural' AKI, measured with new urinary biomarkers, is unknown. Methods. The TRIBE-AKI study was a prospective cohort study of 1594 adults undergoing cardiac surgery at six hospitals between July 2007 and December 2010. We classified the degree of exposure to ACEi/ARB into three categories: 'none' (no exposure prior to surgery), 'held' (on chronic ACEi/ARB but held on the morning of surgery) or 'continued' (on chronic ACEi/ARB and taken the morning of surgery). The co-primary outcomes were 'functional' AKI based upon changes in pre- to postoperative serum creatinine, and 'structural AKI', based upon peak postoperative levels of four urinary biomarkers of kidney injury. Results. Across the three levels (none, held and continued) of ACEi/ARB exposure there was a graded increase in functional AKI, as defined by AKI stage 1 or worse; (31, 34 and 42%, P for trend 0.03) and by percentage change in serum creatinine from pre- to postoperative (25, 26 and 30%, P for trend 0.03). In contrast, there were no differences in structural AKI across the strata of ACEi/ARB exposure, as assessed by four structural AKI biomarkers (neutrophil gelatinase-associated lipocalin, kidney injury molecule-1, interleukin-18 or liver-fatty acid-binding protein). Conclusions. Preoperative ACEi/ARB usage was associated with functional but not structural acute kidney injury. As AKI from ACEi/ARB in this setting is unclear, interventional studies testing different strategies of perioperative ACEi/ARB use are warranted.

KW - Acute renal failure

KW - Biomarkers

KW - Serum creatinine

UR - http://www.scopus.com/inward/record.url?scp=84890044200&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84890044200&partnerID=8YFLogxK

U2 - 10.1093/ndt/gft405

DO - 10.1093/ndt/gft405

M3 - Article

C2 - 24081864

AN - SCOPUS:84890044200

VL - 28

SP - 2787

EP - 2799

JO - Nephrology Dialysis Transplantation

JF - Nephrology Dialysis Transplantation

SN - 0931-0509

IS - 11

ER -