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ACE Inhibitors, Angiotensin-Receptor Blockers Tied to Increase in Kidney Admissions — Physician’s First Watch

Medical News |
November 7, 2013

ACE Inhibitors, Angiotensin-Receptor Blockers Tied to Increase in Kidney Admissions

By Amy Orciari Herman

Increases in prescriptions for angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) in recent years may have contributed to an increase in hospital admissions for acute kidney injury, according to a PLoS ONE study.

U.K. researchers examined national prescription and hospital admission data from April 2007 through March 2011. Nationwide, ACE-inhibitor and ARB prescriptions increased by about 16% — and admissions for acute kidney injury by 52% — over the study period. In addition, there was "strong evidence" that increases in ACE-inhibitor and ARB prescriptions within particular general practices corresponded to increases in kidney hospitalizations within those practices. The researchers calculate that increases in such prescriptions accounted for 15% (roughly 11,000) of the overall rise in kidney admissions.

Cardiologist Harlan Krumholz of NEJM Journal Watch commented: "This ecological analysis should be interpreted cautiously, as the researchers were limited in their ability to link the use of ACE inhibitors and ARBs by individual patients with an increase in risk. This does not mandate a change in practice. What I find most concerning is the increase in acute kidney injury — and there is an urgent need for patient-level studies to determine what is fueling the elevation in risk."

Reader Comments (5)

Antonio Machado Physician, Internal Medicine, Hospital Santa Maria

Any relationship with raining?

CHRISTOPHER THOMAS Physician, Family Medicine/General Practice

I have seen this occur in patients who were taking these medicines, often in conjunction with a diuretic, who then became ill with a presumed gastrointestinal illness, especially in the summer months. Was this or any other possible contributing factors examined?

Ruda Mohaweche Physician, Internal Medicine, Caracas, Venezuela

It´s very difficult to asevere that ACEs or ARBs are tied to acute kidney injury when you have many studies soporting the nefroprotector effects of this medication.

PhD Physician, Pharmacology/Pharmacy, School of Medicine, Universitas Sumatera Utara, Indonesia

because of both ACE-inhibitors and ARBs have no free adverse reactions, the use of these agents should be monitored carefully. Once it is found a change in renal function (eg creatinin clearance) then it is an alarm for the physician to modify the treatment.

HYMAN KAPLAN Physician, Allergy/Immunology, Private practice.

Related to concurrent NSAID?

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