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

Research output: Contribution to journalArticle

5 Citations (Scopus)

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).

Original languageEnglish
Pages (from-to)1214-1222
Number of pages9
JournalAnaesthesia
Volume73
Issue number10
DOIs
Publication statusPublished - 1 Oct 2018
Externally publishedYes

Fingerprint

Angiotensin Receptor Antagonists
Angiotensin-Converting Enzyme Inhibitors
Acute Kidney Injury
Cohort Studies
Prospective Studies
Propensity Score
Selection Bias
Ireland
Gastrointestinal Tract
Liver
Incidence
Population

Cite this

@article{6777026dee2649519211e7c236da6626,
title = "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",
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).",
keywords = "acute kidney injury, angiotensin II receptor blockers, angiotensin-converting enzyme inhibitors, postoperative complications",
author = "{STARSurg Collaborative} and Drake, {Thomas M.} and Cheung, {Lok Ka} and Fortis Gaba and James Glasbey and Nathan Griffiths and Helliwell, {Rebecca J.} and Tausif Huq and Rachel Khaw and Jonathan Mayes and Saif Khan and Nasir Rafiq and Evelina Woin and Fitzgerald, {J. Edward} and Harrison, {Ewen M.} and Dmitri Nepogodiev and Drake, {T. M.} and Mike Bath and Aditya Borakati and Joshua Burke and Henry Claireaux and Praveena Deekonda and Buket Gundogan and Holly Joyce and Sivesh Kamarajah and Chetan Khatri and Chia Kong and McLean, {Kenneth A.} and Lisa Mcnamee and Midhun Mohan and Aneel Bhangu and Dmitri Nepogodiev and Nishkantha Arulkumaran and Samira Bell and Fiona Duthie and Jeremy Hughes and John Prowle and Toby Richards and K. Dynes and P. Patel and C. Wigley and R. Suresh and A. Shaw and S. Klimach and P. Jull and D. Evans and R. Preece and I. Ibrahim and V. Manikavasagar and Brown, {F. S.} and P. Deekonda and R. Teo and Sim, {D. P.Y.} and A. Borakati and Logan, {A. E.} and I. Barai and H. Amin and S. Suresh and R. Sethi and W. Bolton and O. Corbridge and L. Horne and M. Attalla and R. Morley and T. Hoskins and R. McAllister and S. Lee and Y. Dennis and G. Nixon and E. Heywood and H. Wilson and L. Ng and S. Samaraweera and A. Mills and C. Doherty and E. Woin and J. Belchos and V. Phan and T. Chouari and T. Gardner and N. Goergen and Hayes, {J. D.B.} and MacLeod, {C. S.} and R. McCormack and A. McKinley and S. McKinstry and W. Milligan and L. Ooi and Rafiq, {N. M.} and T. Sammut and E. Sinclair and M. Smith and C. Baker and Boulton, {A. P.R.} and J. Collins and Copley, {H. C.} and N. Fearnhead and H. Fox and T. Mah and J. McKenna and V. Naruka and N. Nigam and B. Nourallah and S. Perera and A. Qureshi and S. Saggar and L. Sun and X. Wang and Yang, {D. D.} and P. Caroll and C. Doyle and S. Elangovan and A. Falamarzi and {Gascon Pera}, K. and K. i and E. Greenan and D. Jain and M. Lang-Orsini and S. Lim and L. O'Byrne and P. Ridgway and {Van der Laan}, S. and J. Wong and J. Arthur and J. Barclay and P. Bradley and C. Edwin and E. Finch and E. Hayashi and M. Hopkins and D. Kelly and M. Kelly and N. McCartan and A. Ormrod and A. Pakenham and J. Hayward and C. Hitchen and A. Kishore and T. Martins and J. Philomen and R. Rao and C. Rickards and N. Burns and M. Copeland and C. Durand and A. Dyal and A. Ghaffar and A. Gidwani and M. Grant and C. Gribbon and A. Gruhn and M. Leer and K. Ahmad and G. Beattie and M. Beatty and G. Campbell and G. Donaldson and S. Graham and D. Holmes and S. Kanabar and H. Liu and C. McCann and R. Stewart and S. Vara and O. Ajibola-Taylor and Andah, {E. J.E.} and C. Ani and Cabdi, {N. M.O.} and G. Ito and M. Jones and A. Komoriyama and P. Patel and L. Titu and M. Basra and P. Gallogly and G. Harinath and Leong, {S. H.} and A. Pradhan and I. Siddiqui and S. Zaat and A. Ali and M. Galea and Looi, {W. L.} and Ng, {J. C.K.} and G. Atkin and A. Azizi and Z. Cargill and Z. China and J. Elliot and R. Jebakumar and J. Lam and G. Mudalige and C. Onyerindu and M. Renju and {Shankar Babu}, V. and M. Hussain and N. Joji and B. Lovett and H. Mownah and B. Ali and B. Cresswell and Dhillon, {A. K.} and Dupaguntla, {Y. S.} and C. Hungwe and Lowe-Zinola, {J. D.} and Tsang, {J. C.H.} and K. Bevan and C. Cardus and A. Duggal and S. Hossain and M. McHugh and M. Scott and F. Chan and R. Evans and E. Gurung and B. Haughey and B. Jacob-Ramsdale and M. Kerr and J. Lee and E. McCann and K. O'Boyle and N. Reid and F. Hayat and S. Hodgson and R. Johnston and W. Jones and M. Khan and T. Linn and S. Long and P. Seetharam and S. Shaman and B. Smart and A. Anilkumar and J. Davies and J. Griffith and B. Hughes and Y. Islam and D. Kidanu and N. Mushaini and I. Qamar and H. Robinson and M. Schramm and {Yan Tan}, C. and H. Apperley and C. Billyard and Blazeby, {J. M.} and Cannon, {S. P.} and S. Carse and A. G{\"o}pfert and A. Loizidou",
year = "2018",
month = "10",
day = "1",
doi = "10.1111/anae.14349",
language = "English",
volume = "73",
pages = "1214--1222",
journal = "Anaesthesia",
issn = "0003-2409",
publisher = "John Wiley & Sons",
number = "10",

}

TY - JOUR

T1 - Association between peri-operative angiotensin-converting enzyme inhibitors and angiotensin-2 receptor blockers and acute kidney injury in major elective non-cardiac surgery

T2 - a multicentre, prospective cohort study

AU - STARSurg Collaborative

AU - Drake, Thomas M.

AU - Cheung, Lok Ka

AU - Gaba, Fortis

AU - Glasbey, James

AU - Griffiths, Nathan

AU - Helliwell, Rebecca J.

AU - Huq, Tausif

AU - Khaw, Rachel

AU - Mayes, Jonathan

AU - Khan, Saif

AU - Rafiq, Nasir

AU - Woin, Evelina

AU - Fitzgerald, J. Edward

AU - Harrison, Ewen M.

AU - Nepogodiev, Dmitri

AU - Drake, T. M.

AU - Bath, Mike

AU - Borakati, Aditya

AU - Burke, Joshua

AU - Claireaux, Henry

AU - Deekonda, Praveena

AU - Gundogan, Buket

AU - Joyce, Holly

AU - Kamarajah, Sivesh

AU - Khatri, Chetan

AU - Kong, Chia

AU - McLean, Kenneth A.

AU - Mcnamee, Lisa

AU - Mohan, Midhun

AU - Bhangu, Aneel

AU - Nepogodiev, Dmitri

AU - Arulkumaran, Nishkantha

AU - Bell, Samira

AU - Duthie, Fiona

AU - Hughes, Jeremy

AU - Prowle, John

AU - Richards, Toby

AU - Dynes, K.

AU - Patel, P.

AU - Wigley, C.

AU - Suresh, R.

AU - Shaw, A.

AU - Klimach, S.

AU - Jull, P.

AU - Evans, D.

AU - Preece, R.

AU - Ibrahim, I.

AU - Manikavasagar, V.

AU - Brown, F. S.

AU - Deekonda, P.

AU - Teo, R.

AU - Sim, D. P.Y.

AU - Borakati, A.

AU - Logan, A. E.

AU - Barai, I.

AU - Amin, H.

AU - Suresh, S.

AU - Sethi, R.

AU - Bolton, W.

AU - Corbridge, O.

AU - Horne, L.

AU - Attalla, M.

AU - Morley, R.

AU - Hoskins, T.

AU - McAllister, R.

AU - Lee, S.

AU - Dennis, Y.

AU - Nixon, G.

AU - Heywood, E.

AU - Wilson, H.

AU - Ng, L.

AU - Samaraweera, S.

AU - Mills, A.

AU - Doherty, C.

AU - Woin, E.

AU - Belchos, J.

AU - Phan, V.

AU - Chouari, T.

AU - Gardner, T.

AU - Goergen, N.

AU - Hayes, J. D.B.

AU - MacLeod, C. S.

AU - McCormack, R.

AU - McKinley, A.

AU - McKinstry, S.

AU - Milligan, W.

AU - Ooi, L.

AU - Rafiq, N. M.

AU - Sammut, T.

AU - Sinclair, E.

AU - Smith, M.

AU - Baker, C.

AU - Boulton, A. P.R.

AU - Collins, J.

AU - Copley, H. C.

AU - Fearnhead, N.

AU - Fox, H.

AU - Mah, T.

AU - McKenna, J.

AU - Naruka, V.

AU - Nigam, N.

AU - Nourallah, B.

AU - Perera, S.

AU - Qureshi, A.

AU - Saggar, S.

AU - Sun, L.

AU - Wang, X.

AU - Yang, D. D.

AU - Caroll, P.

AU - Doyle, C.

AU - Elangovan, S.

AU - Falamarzi, A.

AU - Gascon Pera, K.

AU - i, K.

AU - Greenan, E.

AU - Jain, D.

AU - Lang-Orsini, M.

AU - Lim, S.

AU - O'Byrne, L.

AU - Ridgway, P.

AU - Van der Laan, S.

AU - Wong, J.

AU - Arthur, J.

AU - Barclay, J.

AU - Bradley, P.

AU - Edwin, C.

AU - Finch, E.

AU - Hayashi, E.

AU - Hopkins, M.

AU - Kelly, D.

AU - Kelly, M.

AU - McCartan, N.

AU - Ormrod, A.

AU - Pakenham, A.

AU - Hayward, J.

AU - Hitchen, C.

AU - Kishore, A.

AU - Martins, T.

AU - Philomen, J.

AU - Rao, R.

AU - Rickards, C.

AU - Burns, N.

AU - Copeland, M.

AU - Durand, C.

AU - Dyal, A.

AU - Ghaffar, A.

AU - Gidwani, A.

AU - Grant, M.

AU - Gribbon, C.

AU - Gruhn, A.

AU - Leer, M.

AU - Ahmad, K.

AU - Beattie, G.

AU - Beatty, M.

AU - Campbell, G.

AU - Donaldson, G.

AU - Graham, S.

AU - Holmes, D.

AU - Kanabar, S.

AU - Liu, H.

AU - McCann, C.

AU - Stewart, R.

AU - Vara, S.

AU - Ajibola-Taylor, O.

AU - Andah, E. J.E.

AU - Ani, C.

AU - Cabdi, N. M.O.

AU - Ito, G.

AU - Jones, M.

AU - Komoriyama, A.

AU - Patel, P.

AU - Titu, L.

AU - Basra, M.

AU - Gallogly, P.

AU - Harinath, G.

AU - Leong, S. H.

AU - Pradhan, A.

AU - Siddiqui, I.

AU - Zaat, S.

AU - Ali, A.

AU - Galea, M.

AU - Looi, W. L.

AU - Ng, J. C.K.

AU - Atkin, G.

AU - Azizi, A.

AU - Cargill, Z.

AU - China, Z.

AU - Elliot, J.

AU - Jebakumar, R.

AU - Lam, J.

AU - Mudalige, G.

AU - Onyerindu, C.

AU - Renju, M.

AU - Shankar Babu, V.

AU - Hussain, M.

AU - Joji, N.

AU - Lovett, B.

AU - Mownah, H.

AU - Ali, B.

AU - Cresswell, B.

AU - Dhillon, A. K.

AU - Dupaguntla, Y. S.

AU - Hungwe, C.

AU - Lowe-Zinola, J. D.

AU - Tsang, J. C.H.

AU - Bevan, K.

AU - Cardus, C.

AU - Duggal, A.

AU - Hossain, S.

AU - McHugh, M.

AU - Scott, M.

AU - Chan, F.

AU - Evans, R.

AU - Gurung, E.

AU - Haughey, B.

AU - Jacob-Ramsdale, B.

AU - Kerr, M.

AU - Lee, J.

AU - McCann, E.

AU - O'Boyle, K.

AU - Reid, N.

AU - Hayat, F.

AU - Hodgson, S.

AU - Johnston, R.

AU - Jones, W.

AU - Khan, M.

AU - Linn, T.

AU - Long, S.

AU - Seetharam, P.

AU - Shaman, S.

AU - Smart, B.

AU - Anilkumar, A.

AU - Davies, J.

AU - Griffith, J.

AU - Hughes, B.

AU - Islam, Y.

AU - Kidanu, D.

AU - Mushaini, N.

AU - Qamar, I.

AU - Robinson, H.

AU - Schramm, M.

AU - Yan Tan, C.

AU - Apperley, H.

AU - Billyard, C.

AU - Blazeby, J. M.

AU - Cannon, S. P.

AU - Carse, S.

AU - Göpfert, A.

AU - Loizidou, A.

PY - 2018/10/1

Y1 - 2018/10/1

N2 - 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).

AB - 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).

KW - acute kidney injury

KW - angiotensin II receptor blockers

KW - angiotensin-converting enzyme inhibitors

KW - postoperative complications

UR - http://www.scopus.com/inward/record.url?scp=85050659487&partnerID=8YFLogxK

U2 - 10.1111/anae.14349

DO - 10.1111/anae.14349

M3 - Article

VL - 73

SP - 1214

EP - 1222

JO - Anaesthesia

JF - Anaesthesia

SN - 0003-2409

IS - 10

ER -