ACE Inhibitors and angiotensin receptor blockers (ACEI/ARB) are drugs commonly used to treat high blood pressure, kidney disease and heart failure. However, it is believed that they may cause a sudden deterioration in kidney function (acute kidney injury - AKI), especially if taken during periods of illness like severe infections. In recent years there have been a number of initiatives to reduce the occurrence of AKI including advising clinicians to stop these drugs for patients with AKI. Anecdotally, this has meant that an increasing number of people are having their ACEI/ARB stopped. There is concern that this could lead to an increase in the number of people having deterioration in the conditions that these drugs are meant to prevent, such as worsening of heart failure or high blood pressure. In this study, among people who were admitted to hospital with AKI while taking ACEI or ARBs, we will examine the proportion who had the drugs represcribed after admission, and whether this is changing over time. We will compare the rates of subsequent admission with heart failure, AKI and stroke, between those who had the drugs stopped with a comparable group of people who continued the medications.
Due to concern about the association between ACE inhibitors (ACEI) and angiotensin receptor blockers (ARBs), and acute kidney injury (AKI), it is thought that a growing proportion of people are having their medication stopped. It is not known if the potential benefits of reducing future AKI risk from stopping ACEI/ARB outweigh an increased risk of admission from other causes. To address this, we will identify a cohort of users of ACEI/ARBs who are admitted to hospital with AKI. We will identify the proportion of these who are represcribed the drugs after admission and examine whether this is changing over time. We will describe total subsequent frequency of readmissions and length of hospital stay. Using poisson regression and adjusting for multiple confounders we will compare the rates of admission with: i) heart failure; ii) AKI; and iii) stroke, between those who do and do not restart an ACEI/ARB following first AKI admission. We will examine whether there is an interaction for the outcome between patients with and without a diagnosis of cardiac failure prior to the AKI admission.
Odds of continued prescription of an ACE Inhibitor or Angiotensin receptor blocker (primary descriptive outcome)
Odds of continued prescription of an ACE Inhibitor or Angiotensin receptor blocker (primary descriptive outcome)
Laurie Tomlinson - Chief Investigator - London School of Hygiene & Tropical Medicine ( LSHTM )
Patrick Bidulka - Corresponding Applicant - London School of Hygiene & Tropical Medicine ( LSHTM )
Clemence Leyrat - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Dorothea Nitsch - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Edward Kingdon - Collaborator - Royal Sussex County Hospital
Erick Wafula Mugoma - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Fontini Kalogirou - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Kate McAllister - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Kathryn Mansfield - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Krishnan Bhaskaran - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Laurie Tomlinson - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Liam Smeeth - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Samantha Wilkinson - Collaborator - Roche
Viyaasan Mahalingasivam - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
HES Admitted Patient Care;HES Outpatient