Adverse clinical outcomes associated with RAAS inhibitor discontinuation: analysis of over 400 000 patients from the UK Clinical Practice Research Datalink (CPRD)
Open Access
- 30 January 2021
- journal article
- research article
- Published by Oxford University Press (OUP) in Clinical Kidney Journal
- Vol. 14 (10), 2203-2212
- https://doi.org/10.1093/ckj/sfab029
Abstract
Users of guideline-recommended renin–angiotensin–aldosterone system (RAAS) inhibitors may experience disruptions to their treatment, e.g. due to hyperkalaemia, hypotension or acute kidney injury. The risks associated with treatment disruption have not been comprehensively assessed; therefore, we evaluated the risk of adverse clinical outcomes in RAAS inhibitor users experiencing treatment disruptions in a large population-wide database. This exploratory, retrospective analysis utilized data from the UK’s Clinical Practice Research Datalink, linked to Hospital Episodes Statistics and the Office for National Statistics databases. Adults (≥18 years) with first RAAS inhibitor use (defined as angiotensin-converting enzyme inhibitors or angiotensin receptor blockers) between 1 January 2009 and 31 December 2014 were eligible for inclusion. Time to the first occurrence of adverse clinical outcomes [all-cause mortality, all-cause hospitalization, cardiac arrhythmia, heart failure hospitalization, cardiac arrest, advancement in chronic kidney disease (CKD) stage and acute kidney injury] was compared between RAAS inhibitor users with and without interruptions or cessations to treatment during follow-up. Associations between baseline characteristics and adverse clinical outcomes were also assessed. Among 434 027 RAAS inhibitor users, the risk of the first occurrence of all clinical outcomes, except advancement in CKD stage, was 8–75% lower in patients without interruptions or cessations versus patients with interruptions/cessations. Baseline characteristics independently associated with increased risk of clinical outcomes included increasing age, smoking, CKD, diabetes and heart failure. These findings highlight the need for effective management of factors associated with RAAS inhibitor interruptions or cessations in patients for whom guideline-recommended RAAS inhibitor treatment is indicated.Keywords
Funding Information
- AstraZeneca
This publication has 34 references indexed in Scilit:
- Obesity and the risk of cardiovascular and all-cause mortality in chronic kidney disease: a systematic review and meta-analysisNephrology Dialysis Transplantation, 2016
- Faculty Opinions recommendation of Association between Serum Potassium and Outcomes in Patients with Reduced Kidney Function.Published by H1 Connect ,2016
- Faculty Opinions recommendation of Multicentre randomized controlled trial of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker withdrawal in advanced renal disease: the STOP-ACEi trial.Published by H1 Connect ,2015
- Multicentre randomized controlled trial of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker withdrawal in advanced renal disease: the STOP-ACEi trialNephrology Dialysis Transplantation, 2015
- The Comparative Efficacy and Safety of the Angiotensin Receptor Blockers in the Management of Hypertension and Other Cardiovascular DiseasesDrug Safety, 2014
- Targets, trends, excesses, and deficiencies: refocusing clinical investigation to improve patient outcomesKidney International, 2013
- Major Barriers against Renin–Angiotensin–Aldosterone System Blocker Use in Chronic Kidney Disease Stages 3–5 in Clinical Practice: A Safety Concern?Renal Failure, 2012
- ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012European Journal of Heart Failure, 2012
- The impact of stopping inhibitors of the renin-angiotensin system in patients with advanced chronic kidney diseaseNephrology Dialysis Transplantation, 2009
- Rates of Hyperkalemia after Publication of the Randomized Aldactone Evaluation StudyThe New England Journal of Medicine, 2004