Abstract

Background: Limited evidence suggests strategies to improve long-term outcomes in patients recovering from dialysis-requiring acute kidney injury (AKI-D). We aimed to evaluate whether the postdischarge use of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) is associated with improved outcomes in these patients.

Methods: This cohort study used data from Taiwan's National Health Insurance database. Between 2001 and 2014, we included hospitalized patients aged ≥ 18 years who recovered from AKI-D and survived 180 days after discharge. Patients taking ACEI/ARB within 180 days of dischargewere matched 1:1 to nonusers using propensity score methods. The outcomes of interest were all-cause mortality and end-stage renal disease (ESRD). We used Cox proportional hazards regression models to analyze the associations between ACEI/ARB use and the outcomes.

Results: A total of 8,463 matched pairs of ACEI/ARB users and nonusers were analyzed. After a median follow-up of 4 years, post-discharge ACEI/ARB was associated with lower all-cause mortality (hazard ratio (HR), 0.95; 95% confidence interval (CI), 0.90–1.00; p = 0.04), but not with ESRD. When considering the dispensing timing, ACEI/ARB use within 90 days of discharge, as compared with nonusers,was associated with lower risks for all-cause mortality (HR, 0.93; 95% CI, 0.88–0.98; p = 0.01) and ESRD (HR, 0.92; 95% CI, 0.85–0.99; p = 0.02).

Conclusion: Our results suggest the potential benefits of post-discharge use of ACEI/ARB in patients surviving AKI-D, plausibly in the window of 3 months  after discharge.