Drake, TM; Cheung, LK; Gaba, F; Glasbey, J; Griffiths, N; Helliwell, RJ; Huq, T; ... Naruka, V; + view all Drake, TM; Cheung, LK; Gaba, F; Glasbey, J; Griffiths, N; Helliwell, RJ; Huq, T; Khaw, R; Mayes, J; Khan, S; Rafiq, N; Woin, E; Fitzgerald, JE; Harrison, EM; Nepogodiev, D; Drake, TM; Bath, M; Borakati, A; Burke, J; Claireaux, H; Deekonda, P; Gundogan, B; Joyce, H; Kamarajah, S; Khatri, C; Kong, C; McLean, KA; Mcnamee, L; Mohan, M; Bhangu, A; Nepogodiev, D; Arulkumaran, N; Bell, S; Duthie, F; Hughes, J; Prowle, J; Richards, T; Dynes, K; Patel, P; Wigley, C; Suresh, R; Shaw, A; Klimach, S; Jull, P; Evans, D; Preece, R; Ibrahim, I; Manikavasagar, V; Brown, FS; Deekonda, P; Teo, R; Sim, DPY; Borakati, A; Logan, AE; Barai, I; Amin, H; Suresh, S; Sethi, R; Bolton, W; Corbridge, O; Horne, L; Attalla, M; Morley, R; Hoskins, T; McAllister, R; Lee, S; Dennis, Y; Nixon, G; Heywood, E; Wilson, H; Ng, L; Samaraweera, S; Mills, A; Doherty, C; Woin, E; Belchos, J; Phan, V; Chouari, T; Gardner, T; Goergen, N; Hayes, JDB; MacLeod, CS; McCormack, R; McKinley, A; McKinstry, S; Milligan, W; Ooi, L; Rafiq, NM; Sammut, T; Sinclair, E; Smith, M; Baker, C; Boulton, APR; Collins, J; Copley, HC; Fearnhead, N; Fox, H; Mah, T; McKenna, J; Naruka, V; - view fewer (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) pp. 1214-1222. 10.1111/anae.14349.

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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).

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