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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

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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).

Citation

STARSurg Collaborative. (2018). 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. Anaesthesia, 73(10), 1214-1222. https://doi.org/10.1111/anae.14349

Journal Article Type Article
Acceptance Date Apr 30, 2018
Online Publication Date Jul 9, 2018
Publication Date Oct 1, 2018
Deposit Date Jun 10, 2019
Publicly Available Date Jun 18, 2019
Journal Anaesthesia
Print ISSN 0003-2409
Electronic ISSN 1365-2044
Publisher Wiley
Peer Reviewed Peer Reviewed
Volume 73
Issue 10
Pages 1214-1222
DOI https://doi.org/10.1111/anae.14349
Keywords Anesthesiology and Pain Medicine
Public URL https://nottingham-repository.worktribe.com/output/1379189
Publisher URL https://onlinelibrary.wiley.com/doi/full/10.1111/anae.14349

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