Impact of angiotensin-converting enzyme inhibitors or receptor blockers on post-ICU discharge outcome in patients with acute kidney injury

Etienne Gayat (1) , Alexa Hollinger (2) , Alain Cariou (3, 4) , Nicolas Deye (5) , Antoine Vieillard-Baron (6) , Samir Jaber (7, 8) , Benjamin Chousterman , Qin Lu (9) , Pierre François Laterre , Xavier Monnet (10, 11) , Michael Darmon (12) , Marc Léone (13) , Bertrand Guidet , Romain Sonneville , Jean-Yves Lefrant (14) , Marie-Céline Fournier , Matthieu Resche-Rigon (15) , Alexandre Mebazaa (1) , Matthieu Legrand (16)

1 Département d'Anesthésie Réanimation SMUR [Paris]
2 AP-HP - Hopital Saint-Louis [AP-HP]
3 Unité de Soins Intensifs [CHU Cochin]
4 AP-HP - Assistance publique - Hôpitaux de Paris (AP-HP)
5 Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris]
6 Service de réanimation medico-chirurgicale [CHU Raymond-Poincaré]
7 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
8 PhyMedExp - Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046]
9 CERV - Centre Européen de Réalité Virtuelle
10 IMRB - Institut Mondor de Recherche Biomédicale
11 HPPIT - Hypertension arterielle pulmonaire physiopathologie et innovation thérapeutique
12 Service de réanimation médicale
13 Hôpital Nord [CHU - APHM]
14 EA 2992 - Caractéristiques féminines des dysfonctions des interfaces cardio-vasculaires
15 Biostatistique et épidemiologie clinique
16 BioCANVAS / U942 - Biomarqueurs CArdioNeuroVASCulaires

Purpose: Acute kidney injury (AKI) is associated with the activation of the renin–angiotensin system. Whether angiotensin-converting enzyme inhibitors (ACEi) or angiotensin-receptor blockers (ARB) improve outcome in patients recovering from AKI remains unexplored. The purpose was to investigate the association between prescription of ACEi/ARB at intensive care unit (ICU) discharge and 1-year outcome in patients recovering from AKI. Methods: Association between ACEi/ARB and 1-year mortality rate was explored in 1551 patients discharged from 21 European ICUs in an observational cohort. One-year all-cause mortality after ICU discharge was the primary endpoint. AKI was defined using the kidney disease improvement global outcome definition. Propensity score matching was used to consider the probability to receive ACEi/ARB at ICU discharge and included chronic heart failure, ACEi/ARB on ICU admission, Charlson Comorbidity Index, age, diabetes mellitus, chronic kidney disease, estimated glomerular filtration rate and arterial blood pressure at ICU discharge vasopressors and renal replacement therapy. Results: Overall, 1-year mortality was 28 and 15% in patients with AKI (n = 611, 39%) and without AKI (n = 940), respectively. In patients with AKI, unadjusted, adjusted and propensity-score matched 1-year mortality rates were lower in patients treated with ACEi/ARB at ICU discharge [HR of 0.55 (0.35–0.89), HR of 0.45 (0.27–0.75), and HR of 0.48 (0.27–0.85, p < 0.001), respectively]. These results were consistent across sensitivity analysis. No association was observed in patients without AKI. Conclusions: In patients discharged alive from the ICU after experiencing AKI, ACEi/ARB prescription at discharge is associated with a decrease in 1-year mortality.

Mots clés: Mortality; ICU discharge; ICU; Critically Ill; Angiotensin-receptor blockers; Acute kidney injury; Angiotensin-converting enzyme inhibitors

Domaines: Urologie et Néphrologie; Pharmacologie

Etienne Gayat, Alexa Hollinger, Alain Cariou, Nicolas Deye, Antoine Vieillard-Baron, et al.. Impact of angiotensin-converting enzyme inhibitors or receptor blockers on post-ICU discharge outcome in patients with acute kidney injury. Intensive Care Medicine, 2018, 44 (5), pp.598-605. ⟨10.1007/s00134-018-5160-6⟩. ⟨hal-01893051⟩