Association between peri-operative angiotensin-converting enzyme inhibitors and angiotensin-2 receptor blockers and acute kidney injury in major elective non-cardiac surgery: a multicentre, prospective cohort study

STARSurg Collaborative

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

The peri-operative use of angiotensin-converting enzyme inhibitors or angiotensin-2 receptor blockers is thought to be associated with an increased risk of postoperative acute kidney injury. To reduce this risk, these agents are commonly withheld during the peri-operative period. This study aimed to investigate if withholding angiotensin-converting enzyme inhibitors or angiotensin-2 receptor blockers peri-operatively reduces the risk of acute kidney injury following major non-cardiac surgery. Patients undergoing elective major surgery on the gastrointestinal tract and/or the liver were eligible for inclusion in this prospective study. The primary outcome was the development of acute kidney injury within seven days of operation. Adjusted multi-level models were used to account for centre-level effects and propensity score matching was used to reduce the effects of selection bias between treatment groups. A total of 949 patients were included from 160 centres across the UK and Republic of Ireland. From this population, 573 (60.4%) patients had their angiotensin-converting enzyme inhibitors or angiotensin-2 receptor blockers withheld during the peri-operative period. One hundred and seventy-five (18.4%) patients developed acute kidney injury; there was no difference in the incidence of acute kidney injury between patients who had their angiotensin-converting enzyme inhibitors or angiotensin-2 receptor blockers continued or withheld (107 (18.7%) vs. 68 (18.1%), respectively; p = 0.914). Following propensity matching, withholding angiotensin-converting enzyme inhibitors or angiotensin-2 receptor blockers did not demonstrate a protective effect against the development of postoperative acute kidney injury (OR (95%CI) 0.89 (0.58–1.34); p = 0.567).

Original languageEnglish (US)
Pages (from-to)1214-1222
Number of pages9
JournalAnaesthesia
Volume73
Issue number10
DOIs
StatePublished - Oct 1 2018

Fingerprint

Angiotensin Receptor Antagonists
Angiotensin-Converting Enzyme Inhibitors
Acute Kidney Injury
Cohort Studies
Prospective Studies
Propensity Score
Selection Bias
Ireland
Gastrointestinal Tract
Liver
Incidence
Population

Keywords

  • acute kidney injury
  • angiotensin II receptor blockers
  • angiotensin-converting enzyme inhibitors
  • postoperative complications

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

@article{04dfc6fe72024302aacaae6b13f314be,
title = "Association between peri-operative angiotensin-converting enzyme inhibitors and angiotensin-2 receptor blockers and acute kidney injury in major elective non-cardiac surgery: a multicentre, prospective cohort study",
abstract = "The peri-operative use of angiotensin-converting enzyme inhibitors or angiotensin-2 receptor blockers is thought to be associated with an increased risk of postoperative acute kidney injury. To reduce this risk, these agents are commonly withheld during the peri-operative period. This study aimed to investigate if withholding angiotensin-converting enzyme inhibitors or angiotensin-2 receptor blockers peri-operatively reduces the risk of acute kidney injury following major non-cardiac surgery. Patients undergoing elective major surgery on the gastrointestinal tract and/or the liver were eligible for inclusion in this prospective study. The primary outcome was the development of acute kidney injury within seven days of operation. Adjusted multi-level models were used to account for centre-level effects and propensity score matching was used to reduce the effects of selection bias between treatment groups. A total of 949 patients were included from 160 centres across the UK and Republic of Ireland. From this population, 573 (60.4{\%}) patients had their angiotensin-converting enzyme inhibitors or angiotensin-2 receptor blockers withheld during the peri-operative period. One hundred and seventy-five (18.4{\%}) patients developed acute kidney injury; there was no difference in the incidence of acute kidney injury between patients who had their angiotensin-converting enzyme inhibitors or angiotensin-2 receptor blockers continued or withheld (107 (18.7{\%}) vs. 68 (18.1{\%}), respectively; p = 0.914). Following propensity matching, withholding angiotensin-converting enzyme inhibitors or angiotensin-2 receptor blockers did not demonstrate a protective effect against the development of postoperative acute kidney injury (OR (95{\%}CI) 0.89 (0.58–1.34); p = 0.567).",
keywords = "acute kidney injury, angiotensin II receptor blockers, angiotensin-converting enzyme inhibitors, postoperative complications",
author = "{STARSurg Collaborative} and Drake, {Thomas M.} and Cheung, {Lok Ka} and Fortis Gaba and James Glasbey and Nathan Griffiths and Helliwell, {Rebecca J.} and Tausif Huq and Rachel Khaw and Jonathan Mayes and Saif Khan and Nasir Rafiq and Evelina Woin and Fitzgerald, {J. Edward} and Harrison, {Ewen M.} and Dmitri Nepogodiev and Drake, {T. M.} and Mike Bath and Aditya Borakati and Joshua Burke and Henry Claireaux and Praveena Deekonda and Buket Gundogan and Holly Joyce and Sivesh Kamarajah and Chetan Khatri and Chia Kong and McLean, {Kenneth A.} and Lisa Mcnamee and Midhun Mohan and Aneel Bhangu and Dmitri Nepogodiev and Nishkantha Arulkumaran and Samira Bell and Fiona Duthie and Jeremy Hughes and John Prowle and Toby Richards and K. Dynes and P. Patel and C. Wigley and R. Suresh and A. Shaw and S. Klimach and P. Jull and D. Evans and R. Preece and I. Ibrahim and V. Manikavasagar and Brown, {F. S.} and Turner, {Stephen T}",
year = "2018",
month = "10",
day = "1",
doi = "10.1111/anae.14349",
language = "English (US)",
volume = "73",
pages = "1214--1222",
journal = "Anaesthesia",
issn = "0003-2409",
publisher = "Wiley-Blackwell",
number = "10",

}

TY - JOUR

T1 - Association between peri-operative angiotensin-converting enzyme inhibitors and angiotensin-2 receptor blockers and acute kidney injury in major elective non-cardiac surgery

T2 - a multicentre, prospective cohort study

AU - STARSurg Collaborative

AU - Drake, Thomas M.

AU - Cheung, Lok Ka

AU - Gaba, Fortis

AU - Glasbey, James

AU - Griffiths, Nathan

AU - Helliwell, Rebecca J.

AU - Huq, Tausif

AU - Khaw, Rachel

AU - Mayes, Jonathan

AU - Khan, Saif

AU - Rafiq, Nasir

AU - Woin, Evelina

AU - Fitzgerald, J. Edward

AU - Harrison, Ewen M.

AU - Nepogodiev, Dmitri

AU - Drake, T. M.

AU - Bath, Mike

AU - Borakati, Aditya

AU - Burke, Joshua

AU - Claireaux, Henry

AU - Deekonda, Praveena

AU - Gundogan, Buket

AU - Joyce, Holly

AU - Kamarajah, Sivesh

AU - Khatri, Chetan

AU - Kong, Chia

AU - McLean, Kenneth A.

AU - Mcnamee, Lisa

AU - Mohan, Midhun

AU - Bhangu, Aneel

AU - Nepogodiev, Dmitri

AU - Arulkumaran, Nishkantha

AU - Bell, Samira

AU - Duthie, Fiona

AU - Hughes, Jeremy

AU - Prowle, John

AU - Richards, Toby

AU - Dynes, K.

AU - Patel, P.

AU - Wigley, C.

AU - Suresh, R.

AU - Shaw, A.

AU - Klimach, S.

AU - Jull, P.

AU - Evans, D.

AU - Preece, R.

AU - Ibrahim, I.

AU - Manikavasagar, V.

AU - Brown, F. S.

AU - Turner, Stephen T

PY - 2018/10/1

Y1 - 2018/10/1

N2 - The peri-operative use of angiotensin-converting enzyme inhibitors or angiotensin-2 receptor blockers is thought to be associated with an increased risk of postoperative acute kidney injury. To reduce this risk, these agents are commonly withheld during the peri-operative period. This study aimed to investigate if withholding angiotensin-converting enzyme inhibitors or angiotensin-2 receptor blockers peri-operatively reduces the risk of acute kidney injury following major non-cardiac surgery. Patients undergoing elective major surgery on the gastrointestinal tract and/or the liver were eligible for inclusion in this prospective study. The primary outcome was the development of acute kidney injury within seven days of operation. Adjusted multi-level models were used to account for centre-level effects and propensity score matching was used to reduce the effects of selection bias between treatment groups. A total of 949 patients were included from 160 centres across the UK and Republic of Ireland. From this population, 573 (60.4%) patients had their angiotensin-converting enzyme inhibitors or angiotensin-2 receptor blockers withheld during the peri-operative period. One hundred and seventy-five (18.4%) patients developed acute kidney injury; there was no difference in the incidence of acute kidney injury between patients who had their angiotensin-converting enzyme inhibitors or angiotensin-2 receptor blockers continued or withheld (107 (18.7%) vs. 68 (18.1%), respectively; p = 0.914). Following propensity matching, withholding angiotensin-converting enzyme inhibitors or angiotensin-2 receptor blockers did not demonstrate a protective effect against the development of postoperative acute kidney injury (OR (95%CI) 0.89 (0.58–1.34); p = 0.567).

AB - The peri-operative use of angiotensin-converting enzyme inhibitors or angiotensin-2 receptor blockers is thought to be associated with an increased risk of postoperative acute kidney injury. To reduce this risk, these agents are commonly withheld during the peri-operative period. This study aimed to investigate if withholding angiotensin-converting enzyme inhibitors or angiotensin-2 receptor blockers peri-operatively reduces the risk of acute kidney injury following major non-cardiac surgery. Patients undergoing elective major surgery on the gastrointestinal tract and/or the liver were eligible for inclusion in this prospective study. The primary outcome was the development of acute kidney injury within seven days of operation. Adjusted multi-level models were used to account for centre-level effects and propensity score matching was used to reduce the effects of selection bias between treatment groups. A total of 949 patients were included from 160 centres across the UK and Republic of Ireland. From this population, 573 (60.4%) patients had their angiotensin-converting enzyme inhibitors or angiotensin-2 receptor blockers withheld during the peri-operative period. One hundred and seventy-five (18.4%) patients developed acute kidney injury; there was no difference in the incidence of acute kidney injury between patients who had their angiotensin-converting enzyme inhibitors or angiotensin-2 receptor blockers continued or withheld (107 (18.7%) vs. 68 (18.1%), respectively; p = 0.914). Following propensity matching, withholding angiotensin-converting enzyme inhibitors or angiotensin-2 receptor blockers did not demonstrate a protective effect against the development of postoperative acute kidney injury (OR (95%CI) 0.89 (0.58–1.34); p = 0.567).

KW - acute kidney injury

KW - angiotensin II receptor blockers

KW - angiotensin-converting enzyme inhibitors

KW - postoperative complications

UR - http://www.scopus.com/inward/record.url?scp=85050659487&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85050659487&partnerID=8YFLogxK

U2 - 10.1111/anae.14349

DO - 10.1111/anae.14349

M3 - Article

C2 - 29984818

AN - SCOPUS:85050659487

VL - 73

SP - 1214

EP - 1222

JO - Anaesthesia

JF - Anaesthesia

SN - 0003-2409

IS - 10

ER -