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Associations between preoperative continuation of renin-angiotensin system inhibitor and cardiac surgery-associated acute kidney injury: a propensity score-matching analysis.

Abstract：

BACKGROUND:Cardiac surgery-associated acute kidney injury (CSA-AKI) is associated with high risk for complications and mortality. Whether renin-angiotensin system (RAS) inhibitor should be continued or withdrawn in patients with long-term use before cardiac surgery has been lack of consensus. METHODS:We performed this prospective observational cohort study and recruited cardiac surgery patients in the surgical intensive care units between 2000 and 2011. These patients were divided into users and non-users of RAS inhibitor. Propensity score matching and multivariable models were performed to investigate the association between renal outcome, mortality, and preoperative use of RAS inhibitor. RESULTS:Preoperative use of RAS inhibitor was identified as the independent protective factor for AKI development (OR 0.41, 95% CI 0.23, 0.63), AKI severity (stage 3 vs. stage 1, OR 0.35, 95% CI 0.18, 0.69), and renal recovery (OR 3.41, 95% CI 1.84, 5.36). Nevertheless, there was no significant protective effect of RAS inhibitor on in-hospital dialysis, in-hospital mortality, and ensuing development of chronic kidney disease (CKD) after AKI. We created a prediction model of CSA-AKI and indicated that preoperative use of RAS inhibitor provided more protective effect in low-risk than high-risk population. CONCLUSION:Preoperative use of RAS inhibitor was associated with less AKI development and severity, and higher renal recovery. Although more risk reduction of AKI development was shown in low-risk group by our prediction model, continued use of RAS inhibitor before cardiac surgery could provide protective effect in all patients.

journal_name

J Nephrol

journal_title

Journal of nephrology

authors

Chou YH,Huang TM,Wu VC,Chen WS,Wang CH,Chou NK,Chiang WC,Chu TS,Lin SL,National Taiwan University Study Group on Acute Renal Failure (NSARF).

doi

10.1007/s40620-019-00657-4

subject

Has Abstract

pub_date

2019-12-01 00:00:00

pages

957-966

issue

eissn

1121-8428

issn

1724-6059

pii

10.1007/s40620-019-00657-4

journal_volume

pub_type

杂志文章,多中心研究

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Associations between preoperative continuation of renin-angiotensin system inhibitor and cardiac surgery-associated acute kidney injury: a propensity score-matching analysis.