The effects of discontinuation versus continuation of ACE-inhibitors and ARBs on kidney function, mortality and length of hospital stay in patients with acute kidney injury

Abstract

Abstract

Background/Introduction Researching the effects of ACE-inhibitors (ACEi) and angiotensin receptor blockers (ARBs) discontinuation versus continuation in patients with acute kidney injury (AKI) on kidney function, mortality, complications and length of hospital stay.

Methods A retrospective observational study in Meander Medical centre in the Netherlands, which included 966 patients with acute kidney injury between november 2022 and january 2025. Patients using an ACE-inhibitor or ARB <72 hours before the onset of AKI were analyzed. SPSS was used for statistical analysis. Differences in continuous were calculated using the independent T-test and the Chi-square test for categorical variables. Results were considered statistically significant if the p-value is <0.05. Hypotensive patients, patients receiving intravenous fluid and heart failure patients were sub analyzed.

Results 231 patients discontinued and 102 patients continued using an ACEi/ARB during AKI. The discontinuation group had a higher mean maximum creatinine (247µmol/L vs 163µmol/L, p <0.001), a lower eGFR (28.99 mL/min/1.73m² vs 42.11 mL/min/1.73m², p <0.001) during AKI and a higher post AKI creatinine value (125 µmol/L vs 107 µmol/L, p = 0.01). There was no difference in post AKI eGFR (50 µmol/L vs 53 µmol/L, p = 0.237). There was no significant difference in mortality(26% vs 18%, p = 0.111) or complication rate.

Conclusions Discontinuation of ACEi/ARBs in patients with an AKI might be associated with more eGFR loss, a lower kidney function during the AKI and a longer hospital admission. There was no difference in post AKI kidney function, mortality and complications. Continuing ACEi/ARBs showed less eGFR loss during the AKI and less eGFR recovery in all patients. Hypotensive patients continuing an ACEi/ARB did have a significantly worse post AKI renal outcome. However, a causal relationship between ACEi/ARBs and the outcomes remains unclear, further research with a randomized study design is recommended.