Continuing Renin-Angiotensin-Aldosterone System Inhibitors in Patients Admitted to the Intensive Care Unit With Mild Deterioration of Renal Function.

Abstract

To investigate the impact of continuing premorbid renin-angiotensin-aldosterone system inhibitor (RAASi) use in patients admitted to the intensive care unit (ICU) with and without stage 1 acute kidney injury (AKI). We retrospectively identified 3146 patients who had been on RAASi treatment for more than 28 days and were admitted to the ICU from January 1, 2011, to December 31, 2018. After excluding patients with preexisting dialysis, advanced AKI, hyperkalemia, or hypotension, 1576 patients were included. Patients who continued RAASi treatment during their ICU stay were categorized as "RAASi users," while those switched to alternative antihypertensive agents were categorized as "nonusers." The primary end point was incidence of advanced (stage 2 to 3) AKI with 7 days of ICU admission. The mean baseline serum creatinine level of the enrolled patients was 1.5 mg/dL, and 290 (18.4%) had stage 1 AKI at admission. After propensity score matching, RAASi users did not have an increased risk of stage 2 to 3 AKI (hazard ratio [HR], 0.82; 95% CI, 0.63 to 1.06). The RAASi users had a significantly lower risk of mortality (HR, 0.69; 95% CI, 0.54 to 0.88; P=.003) and need for dialysis (HR, 0.64; 95% CI, 0.50 to 0.81; P<.001) within 90 days. Compared with nonusers, patients who had RAASi treatment during the ICU stay were more likely to continue RAASi use after hospital discharge (3.7% [23 of 621] vs 86.1% [544 of 632]). Nevertheless, the 90-day mortality of nonusers who resumed RAASi treatment at discharge was noninferior to that of those who continued RAASi use during the ICU stay. Continuing RAASi use did not increase the risk of advanced AKI or mortality in ICU-admitted patients. Adherence to RAASi treatment is associated with improved long-term survival in patients without hypotension at ICU admission.