Abstract | BACKGROUND: METHODS: The TRIBE-AKI study was a prospective cohort study of 1594 adults undergoing cardiac surgery at six hospitals between July 2007 and December 2010. We classified the degree of exposure to ACEi/ARB into three categories: 'none' (no exposure prior to surgery), 'held' (on chronic ACEi/ARB but held on the morning of surgery) or 'continued' (on chronic ACEi/ARB and taken the morning of surgery). The co-primary outcomes were 'functional' AKI based upon changes in pre- to postoperative serum creatinine, and 'structural AKI', based upon peak postoperative levels of four urinary biomarkers of kidney injury. RESULTS: Across the three levels (none, held and continued) of ACEi/ARB exposure there was a graded increase in functional AKI, as defined by AKI stage 1 or worse; (31, 34 and 42%, P for trend 0.03) and by percentage change in serum creatinine from pre- to postoperative (25, 26 and 30%, P for trend 0.03). In contrast, there were no differences in structural AKI across the strata of ACEi/ARB exposure, as assessed by four structural AKI biomarkers ( neutrophil gelatinase-associated lipocalin, kidney injury molecule-1, interleukin-18 or liver-fatty acid-binding protein). CONCLUSIONS: Preoperative ACEi/ARB usage was associated with functional but not structural acute kidney injury. As AKI from ACEi/ARB in this setting is unclear, interventional studies testing different strategies of perioperative ACEi/ARB use are warranted.
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Authors | Steven G Coca, Amit X Garg, Madhav Swaminathan, Susan Garwood, Kwangik Hong, Heather Thiessen-Philbrook, Cary Passik, Jay L Koyner, Chirag R Parikh, TRIBE-AKI Consortium |
Journal | Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
(Nephrol Dial Transplant)
Vol. 28
Issue 11
Pg. 2787-99
(Nov 2013)
ISSN: 1460-2385 [Electronic] England |
PMID | 24081864
(Publication Type: Journal Article, Multicenter Study, Research Support, N.I.H., Extramural)
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Chemical References |
- Angiotensin Receptor Antagonists
- Angiotensin-Converting Enzyme Inhibitors
- Biomarkers
- Receptors, Angiotensin
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Topics |
- Acute Kidney Injury
(chemically induced, diagnosis)
- Adult
- Aged
- Angiotensin Receptor Antagonists
(adverse effects)
- Angiotensin-Converting Enzyme Inhibitors
(adverse effects)
- Biomarkers
(urine)
- Cardiac Surgical Procedures
- Coronary Artery Disease
(surgery)
- Female
- Humans
- Incidence
- Kidney Function Tests
- Male
- Middle Aged
- Preoperative Care
- Prognosis
- Prospective Studies
- Receptors, Angiotensin
(chemistry)
- United States
(epidemiology)
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