Renin-angiotensin system blockers and 1-year mortality in patients with post-operative acute kidney injury.
Renin-angiotensin system blockers and 1-year mortality in patients with post-operative acute kidney injury.
复制标题
肾素-血管紧张素系统阻滞剂和术后急性肾损伤患者的 1 年死亡率。
DOI：
10.1111/aas.13654
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发表时间：
2020
影响因子：
2.1
通讯作者：
Christiansen,ChristianF
中科院分区：
文献类型：
--
作者：
Slagelse,Charlotte;Gammelager,Henrik;Iversen,LeneH;Liu,KathleenD;Sørensen,HenrikT;Christiansen,ChristianF
血管紧张素转换酶抑制剂（ACE-I）和血管紧张素受体阻滞剂（ARB）使用者可能与术后急性肾损伤（阿基）患者死亡率增加相关，但数据有限。我们研究了结直肠癌手术（CRC）后阿基的ACE‐I/ARB使用者是否与阿基后1年死亡率增加相关。MethodsThis population-based cohort study in北方丹麦，包括2005 - 2014年CRC手术后7天内阿基的患者。根据报销处方，将患者分类为ACE‐I/ARB当前使用者、既往使用者或非使用者。我们使用Kaplan-Meier方法（1-生存函数）计算了阿基后30天和1年的累积死亡率及其95%置信区间（95% CI）。通过考克斯比例风险回归分析，控制潜在的混杂因素，计算了当前和以前使用者与非使用者的死亡率的风险比（HR），我们确定了10 713例CRC手术患者。共有2000例阿基患者入选。当前、既往和非使用者的30天死亡率分别为16.5%（95% CI 13.7 - 19.8）、16.2%（95% CI 11.3 - 22.8）和13.4%（95% CI 11.6 - 15.4）。与非使用者相比，当前和既往使用者的校正HR分别为1.26（95% CI 0.96 - 1.65）和1.19（95% CI 0.78 - 1.82）。当前、既往和非使用者的1年死亡率分别为26.4%（95% CI 22.9 - 30.4）、29.8%（95% CI 23.2 - 37.8）和24.7%（95% CI 22.4 - 27.2）。与非使用者相比，当前和既往使用者的校正1年死亡HR分别为1.29（95% CI 0.96 - 1.73）和1.11（95% CI 0.91 - 1.35）。结论根据我们的研究结果，当前使用ACE‐I/ARB的患者术后阿基后1年的死亡率可能略有增加，尽管确定性程度较低。
BackgroundAngiotensin‐converting enzyme inhibitor (ACE‐I) and angiotensin‐receptor blocker (ARB) users may be associated with increased mortality in patients with post‐operative acute kidney injury (AKI), but data are limited. We studied whether users of ACE‐I/ARBs with AKI after colorectal cancer surgery (CRC) were associated with increased 1‐year mortality after AKI.MethodsThis population‐based cohort study in Northern Denmark included patients with AKI within 7 days after CRC surgery during 2005‐2014. From reimbursed prescriptions, patients were classified as ACE‐I/ARB current, former, or non‐users. We computed the cumulative 30‐day and 1‐year mortality after AKI with 95% confidence intervals (95% CI) using the Kaplan‐Meier method (1—survival function). Hazard ratios (HRs) comparing mortality in current and former users with non‐users were computed by Cox proportional hazards regression analyses, controlling for potential confounders.ResultsWe identified 10 713 CRC surgery patients. A total of 2000 patients had AKI and were included. Thirty‐day mortality was 16.5% (95% CI 13.7‐19.8), 16.2% (95% CI 11.3‐22.8), and 13.4% (95% CI 11.6‐15.4) for current, former, and non‐users. Adjusted HR was 1.26 (95% CI 0.96‐1.65) and 1.19 (95% CI 0.78‐1.82) for current and former users compared with non‐users. One‐year mortality rates were 26.4% (95% CI 22.9‐30.4), 29.8% (95% CI 23.2‐37.8), and 24.7% (95% CI 22.4‐27.2) in current, former, and non‐users. Compared with non‐users, the adjusted 1‐year HR for death in current and former users were 1.29 (95% CI 0.96‐1.73) and 1.11 (95% CI 0.91‐1.35).ConclusionBased on our findings, current users of ACE‐I/ARB may possibly have a small increase in mortality rate in the year after post‐operative AKI, although the degree of certainty is low.