Introduction:

Angiotensin-converting enzyme inhibitor (ACE-I) and angiotensin receptor blocker (ARB) discontinuation during acute heart failure (AHF) is associated with increased mortality following hospitalization. Although the etiology of acute kidney injury (AKI) in type 1 cardiorenal syndrome (CRS) has been linked to renal venous congestion, ACE-I/ARB withdrawal (AW) theoretically promotes renal function recovery. ACE-I/ARBs are dose-reduced or withheld in approximately half of patients with CRS, but the subsequent impact on renal function remains largely uninvestigated. This study compared AW to ACE-I/ARB continuation (AC) during CRS.

Methods:

This was a retrospective, single-center chart review. Patients aged 18-89 years admitted from April 2018 to August 2019 with AHF and AKI were identified using discharge ICD-10 codes. All patients were treated with an ACE-I/ARB before admission. Key exclusion criteria included shock, pregnancy, and end-stage renal disease. The primary endpoint was change in serum creatinine (SCr) from admission through 72 hours. Data were analyzed utilizing chi-square and Mann-Whitney U tests with SPSS software.

Results:

A total of 111 admissions were included. AW occurred in 68 patients upon admission. AW patients presented with a higher blood urea nitrogen (P = 0.034), higher SCr (P = 0.021), and lower ejection fraction (P = 0.04). Median SCr change from admission to 72 hours did not differ between groups (AW −0.1 mg/dL vs AC 0.0 mg/dL, P = 0.05). There was no difference in SCr reduction ≥0.3 mg/dL at 72 hours, 30-day readmissions, or ACE-I/ARB prescription at discharge.

Conclusions:

In patients with type 1 CRS, AW was not associated with improved renal function at 72 hours. A larger sample size is necessary to confirm these results.

中文翻译：

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血管紧张素转换酶抑制剂和血管紧张素受体阻滞剂对 1 型心肾综合征肾功能的影响

介绍：

急性心力衰竭 (AHF) 期间停用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) 与住院后死亡率增加有关。尽管 1 型心肾综合征 (CRS) 中急性肾损伤 (AKI) 的病因与肾静脉充血有关，但 ACE-I/ARB 停药 (AW) 理论上可促进肾功能恢复。在大约一半的 CRS 患者中，ACE-I/ARB 的剂量减少或不使用，但随后对肾功能的影响在很大程度上仍未研究。本研究将 AW 与 CRS 期间的 ACE-I/ARB 延续 (AC) 进行了比较。

方法：

这是一个回顾性的单中心图表审查。使用出院 ICD-10 代码确定 2018 年 4 月至 2019 年 8 月期间入院的 18-89 岁 AHF 和 AKI 患者。所有患者在入院前均接受了 ACE-I/ARB 治疗。主要排除标准包括休克、妊娠和终末期肾病。主要终点是从入院到 72 小时血清肌酐 (SCr) 的变化。使用 SPSS 软件使用卡方检验和 Mann-Whitney U 检验分析数据。

结果：

共有 111 名学生被录取。入院时 68 名患者发生 AW。AW 患者出现较高的血尿素氮 ( P = 0.034)、较高的 SCr ( P = 0.021) 和较低的射血分数 ( P = 0.04)。从入院到 72 小时的中位 SCr 变化在各组之间没有差异（AW -0.1 mg/dL vs AC 0.0 mg/dL，P = 0.05）。72 小时、30 天再入院或出院时 ACE-I/ARB 处方时 SCr 降低≥0.3 mg/dL 没有差异。

结论：

在 1 型 CRS 患者中，AW 与 72 小时肾功能改善无关。需要更大的样本量来确认这些结果。