November 6th, 2013
ACE Inhibitors, Angiotensin-Receptor Blockers Tied to Increase in Kidney Admissions
Nicholas Downing, MD
Increases in prescriptions for angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) in recent years may have contributed to an increase in hospital admissions for acute kidney injury, according to a PLoS ONE study.
U.K. researchers examined national prescription and hospital admission data from April 2007 through March 2011. Nationwide, ACE-inhibitor and ARB prescriptions increased by about 16% — and admissions for acute kidney injury by 52% — over the study period. In addition, there was “strong evidence” that increases in ACE-inhibitor and ARB prescriptions within particular general practices corresponded to increases in kidney hospitalizations within those practices. The researchers calculate that increases in such prescriptions accounted for 15% (roughly 11,000) of the overall rise in kidney admissions.
CardioExchange’s Harlan Krumholz commented: “This ecological analysis should be interpreted cautiously, as the researchers were limited in their ability to link the use of ACE inhibitors and ARBs by individual patients with an increase in risk. This does not mandate a change in practice. What I find most concerning is the increase in acute kidney injury — and there is an urgent need for patient-level studies to determine what is fueling the elevation in risk.”
Originally published in Physician’s First Watch
3 Responses to “ACE Inhibitors, Angiotensin-Receptor Blockers Tied to Increase in Kidney Admissions”
NEJM Journal Watch — Recent Cardiology Articles- To Lower Stroke Risk in Patients Undergoing Atrial Fibrillation Ablation, Is a Device or a Medication Better?
- Intensive vs. Standard Blood Pressure Lowering in Patients with Diabetes
- Anticoagulation in Patients with Cancer-Associated Pulmonary Embolism: How Long is Long Enough?
- Spironolactone Use After Percutaneous Intervention for Acute Myocardial Infarction
- CRISPR/Cas9 Gene Editing for Transthyretin Cardiomyopathy
Is this a question of not monitoring increases in creatinine when one first starts or increases the dose of these classes of medications? I agree more study is needed before any change in practice occurs.
What about reverse causality? Perhaps the prevalence of individuals with renal disease increased overtime, which led to increased prescribing of ace-inhibitors and ARBs. Analysis at the practice level may have difficulty teasing this out.
I have seen this occur a few times in the context of an acute gastrointestinal illness and often when a diuretic was also being taken. I wonder if such factors were considered in this study. I have begun to advise my patients pre-emptively of such circumstances.