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Observational Study
. 2017 Apr 13:7:46518.
doi: 10.1038/srep46518.

Renin-Angiotensin System Inhibitor is Associated with Lower Risk of Ensuing Chronic Kidney Disease after Functional Recovery from Acute Kidney Injury

Yu-Hsiang Chou  1   2   3 , Tao-Min Huang  1 , Szu-Yu Pan  1   3   4 , Chin-Hao Chang  5 , Chun-Fu Lai  1 , Vin-Cent Wu  1 , Ming-Shiou Wu  1 , Kwan-Dun Wu  1 , Tzong-Shinn Chu  1 , Shuei-Liong Lin  1   3   6   7
Affiliations
Observational Study

Renin-Angiotensin System Inhibitor is Associated with Lower Risk of Ensuing Chronic Kidney Disease after Functional Recovery from Acute Kidney Injury

Yu-Hsiang Chou et al. Sci Rep. .

Abstract

Acute kidney injury (AKI) is an independent risk factor for ensuing chronic kidney disease (CKD). Animal studies have demonstrated that renin-angiotensin system (RAS) inhibitor can reduce ensuing CKD after functional recovery from AKI. Here we study the association between ensuing CKD and use of RAS inhibitor including angiotensin converting enzyme inhibitor or angiotensin II type 1a receptor blocker starting after renal functional recovery in our prospectively collected observational AKI cohort. Adult patients who had cardiac surgery-associated AKI (CSA-AKI) are studied. Patients with CKD, unrecovered AKI, and use of RAS inhibitor before surgery are excluded. Among 587 eligible patients, 94 patients are users of RAS inhibitor which is started and continued after complete renal recovery during median follow-up period of 2.99 years. The users of RAS inhibitor show significantly lower rate of ensuing CKD (users vs. non-users, 26.6% vs. 42.2%) and longer median CKD-free survival time (users vs. non-users, 1079 days vs. 520 days). Multivariate Cox regression analyses further demonstrate that use of RAS inhibitor is independently associated with lower risk of ensuing CKD (hazard ratio = 0.46, P < 0.001). We conclude that use of RAS inhibitor in CSA-AKI patients after renal functional recovery is associated with lower risk of ensuing CKD development.

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Conflict of interest statement

The authors declare no competing financial interests.

Figures

Figure 1
Figure 1. Flow diagram of patient enrollment.
Patients hospitalized between January 1, 2000 and December 31, 2011 were screened using inclusion and exclusion criteria. Totally 587 patients were identified for final analysis. Abbreviation: AKI, acute kidney injury; CKD, chronic kidney disease; RAS, renin-angiotensin system.
Figure 2
Figure 2. Kaplan-Meier analysis of CKD-free-survival for users and non-users of RAS inhibitor.
Figure 3
Figure 3. Hazard ratio (95% confidence interval) for ensuing CKD associated with use of RAS inhibitor in subgroups of enrolled patients.
Abbreviation: CI, confidence interval; HTN, hypertension.
See this image and copyright information in PMC

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