BACKGROUND The risk of acute kidney injury (AKI) attributable to renin angiotensin aldosterone (RAAS) inhibitors and diuretics remains unclear. METHODS We conducted a prospective cohort study using the Clinical Practice Research Datalink (2008-2015) linked to Hospital Episode Statistics - Admitted Patient Care and Office for National Statistics mortality data. Patients were included if they had one or more chronic diagnoses requiring medication. Exposed patients had a first ever prescription for RAAS inhibitors/diuretics during the study period. AKI risk associated with exposure was determined by multivariable Cox regression, propensity score-adjusted Cox regression and a prior event rate ratio (PERR) analysis. RESULTS One hundred forty thousand nine hundred fifty-two individuals were included. Increased AKI risk in the exposed group was demonstrated in both the multivariable and propensity score-adjusted cox regressions (HR 1.23 (95% CI 1.04-1.45) and HR 1.24 (1.05-1.47) respectively). The PERR analysis provided a similar overall hazard ratio with a wider confidence interval (HR 1.29 (0.94-1.63)). The increased AKI risk in the exposed group was present only in those receiving two or more antihypertensives. Absolute AKI risk was small. CONCLUSIONS RAAS inhibitors/diuretics result in an increased risk of AKI. The absolute increase in AKI risk is small, however, and needs to be considered in the context of any potential benefits.

中文翻译：

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估计与利尿剂和肾素血管紧张素醛固酮系统抑制剂的使用相关的急性肾损伤的风险：使用临床实践研究数据链的一项基于人群的队列研究。

背景技术归因于肾素血管紧张素醛固酮（RAAS）抑制剂和利尿剂的急性肾损伤（AKI）的风险尚不清楚。方法我们使用临床实践研究数据链（2008-2015）进行了一项前瞻性队列研究，该数据链接与《医院病情统计》-《允许的患者护理》和国家统计局的死亡率数据相关联。如果患者具有一项或多项需要药物治疗的慢性诊断，则将其包括在内。在研究期间，暴露的患者首次使用RAAS抑制剂/利尿剂。与暴露相关的AKI风险通过多变量Cox回归，倾向评分调整的Cox回归和事前事件发生率比（PERR）分析来确定。结果包括149 592个人。多变量和倾向得分调整的cox回归均显示暴露组AKI风险增加（分别为HR 1.23（95％CI 1.04-1.45）和HR 1.24（1.05-1.47））。PERR分析提供了相似的总体危险比，但具有更大的置信区间（HR 1.29（0.94-1.63））。仅在接受两种或两种以上降压药的人群中，暴露组的AKI风险增加。绝对AKI风险很小。结论RAAS抑制剂/利尿剂导致AKI的风险增加。但是，AKI风险的绝对增加很小，因此需要在考虑任何潜在利益的情况下加以考虑。PERR分析提供了相似的总体危险比，但具有更大的置信区间（HR 1.29（0.94-1.63））。仅在接受两种或两种以上降压药的人群中，暴露组的AKI风险增加。绝对AKI风险很小。结论RAAS抑制剂/利尿剂导致AKI的风险增加。但是，AKI风险的绝对增加很小，因此需要在考虑任何潜在利益的情况下加以考虑。PERR分析提供了相似的总体危险比，但具有更大的置信区间（HR 1.29（0.94-1.63））。仅在接受两种或两种以上降压药的人群中，暴露组的AKI风险增加。绝对AKI风险很小。结论RAAS抑制剂/利尿剂导致AKI的风险增加。但是，AKI风险的绝对增加很小，因此需要在考虑任何潜在利益的情况下加以考虑。