[ { "phenotype_id": "PH570", "phenotype_version_id": 1140, "name": "Acute Kidney Injury", "definition": "Objective: \n\nTo investigate whether there is an association between use of ACE inhibitors (ACEI) and angiotensin receptor blockers (ARB), and risk of acute kidney injury (AKI).\n\n\nDesign: \n\nA time-updated, new-user cohort study among people initiating common antihypertensives (ACEI/ARB, beta-blockers, calcium channel blockers and thiazide diuretics) in primary care between April 1997 and March 2014.\n\n\nParticipants: \n\nAdults initiating antihypertensive drug treatment, with at least one year of registration prior to first prescription, identified from UK primary care practices contributing to the Clinical Practice Research Datalink and eligible for linkage to hospital records data from the Hospital Episode Statistics database.\n\n\nMain outcome measures: \n\nIncidence rate ratio (RR) for first episode of AKI during time exposed to ACEI/ARB compared to time unexposed, estimated using Poisson regression adjusted for age, sex, comorbidities, use of other antihypertensive drugs, and calendar period.\n\n\nResults: \n\nAmong 570,443 participants with a median follow-up of 2.8 years (IQR 0.4 to 7) there were 15,004 first cases of AKI. The overall crude rate of AKI was 6.4/1,000 person years at risk (95% CI 6.30 to 6.50) but varied from 1.63 (1.43 to 1.86) to 662.53 (538.98 to 814.40) depending on, age, comorbidities, and other prescribed drugs. The adjusted RR of AKI during time exposed to ACEI/ARB compared to time unexposed was 1.18 (95% CI 1.13 to 1.23) which was attenuated to 1.12 (95% CI 1.08 to 1.17) after adjustment for non-thiazide diuretic therapy. There was an interaction for the risk of AKI between people using loop diuretics and ACEI/ARB. For those taking loop diuretics, the adjusted RR of AKI during time exposed to ACEI/ARB compared to time unexposed was 0.99 (95% CI 0.92 to 1.06) but it was 1.18 (95% CI 1.13 to 1.24) among people not-exposed to loop diuretics (p<0.001).\n\n\nConclusions: \n\nTreatment with ACEI/ARB alone appears to be associated with a small increase in the rate of AKI which is largely seen among people with low absolute risk of AKI. Among people requiring loop diuretics, who have a high absolute risk of AKI, treatment with ACEI/ARB had no measurable association with AKI.\n\n\n\n\n\n\n\n\n", "implementation": "", "publications": [ { "doi": null, "details": "Kethryn E Mansfield, Dorothea Nitsch, Liam Smeeth, Krishnan Bhaskaram, Laurie A Tomlinson, Renin-angiostensin system blockage and risk of acute kidney injury. 2015." } ], "validation": "", "citation_requirements": "", "created": "2021-10-06T16:25:11.643987Z", "author": "Kethryn E Mansfield, Dorothea Nitsch, Liam Smeeth, Krishnan Bhaskaram, Laurie A Tomlinson", "collections": [ { "name": "ClinicalCodes Repository", "value": 25 }, { "name": "Phenotype Library", "value": 18 } ], "tags": null, "organisation": null, "world_access": 1, "updated": "2021-10-06T16:25:11.644015Z", "sex": [ { "name": "Both", "value": "3" } ], "type": [ { "name": "Disease or syndrome", "value": "2" } ], "ontology": null, "phenoflowid": "", "data_sources": [ { "name": "HES Admitted Patient Care data for CPRD GOLD", "value": 9, "uid": "4bcf64a6-f404-4ef4-ae6e-172512ab5f43", "url": "https://healthdatagateway.org/en/dataset/674", "datasource_id": 674 } ], "coding_system": [ { "name": "ICD10 codes", "value": 4 } ], "event_date_range": "01/04/1997 - 31/03/2014", "concept_information": [ { "concept_id": 1969, "concept_version_id": 5076, "concept_name": "Acute Kidney Injury - Primary Care", "coding_system": { "id": 4, "name": "ICD10 codes", "description": "ICD10 Codes" }, "phenotype_id": "PH570", "phenotype_version_id": 1140, "phenotype_name": "Acute Kidney Injury", "code_attribute_header": [ "Entity type", "Category", "Coding System (ICD-10)" ], "codes": [ { "code": "N14", "description": "Drug- and heavy-metal-induced tubulo-interstitial and tubular conditions", "attributes": { "Entity type": "res30: Acute kidney injury", "Category": "diagnostic", "Coding System (ICD-10)": "ICD-10" } }, { "code": "N14.1", "description": "Nephropathy induced by other drugs, medicaments and biological substances", "attributes": { "Entity type": "res30: Acute kidney injury", "Category": "diagnostic", "Coding System (ICD-10)": "ICD-10" } }, { "code": "N14.2", "description": "Nephropathy induced by unspecified drug, medicament or biological substance", "attributes": { "Entity type": "res30: Acute kidney injury", "Category": "diagnostic", "Coding System (ICD-10)": "ICD-10" } }, { "code": "N17", "description": "Acute renal failure", "attributes": { "Entity type": "res30: Acute kidney injury", "Category": "diagnostic", "Coding System (ICD-10)": "ICD-10" } }, { "code": "N17.0", "description": "Acute renal failure with tubular necrosis", "attributes": { "Entity type": "res30: Acute kidney injury", "Category": "diagnostic", "Coding System (ICD-10)": "ICD-10" } }, { "code": "N17.1", "description": "Acute renal failure with acute cortical necrosis", "attributes": { "Entity type": "res30: Acute kidney injury", "Category": "diagnostic", "Coding System (ICD-10)": "ICD-10" } }, { "code": "N17.2", "description": "Acute renal failure with medullary necrosis", "attributes": { "Entity type": "res30: Acute kidney injury", "Category": "diagnostic", "Coding System (ICD-10)": "ICD-10" } }, { "code": "N17.8", "description": "Other acute renal failure", "attributes": { "Entity type": "res30: Acute kidney injury", "Category": "diagnostic", "Coding System (ICD-10)": "ICD-10" } }, { "code": "N17.9", "description": "Acute renal failure, unspecified", "attributes": { "Entity type": "res30: Acute kidney injury", "Category": "diagnostic", "Coding System (ICD-10)": "ICD-10" } }, { "code": "N19", "description": "Unspecified kidney failure", "attributes": { "Entity type": "res30: Acute kidney injury", "Category": "diagnostic", "Coding System (ICD-10)": "ICD-10" } }, { "code": "N99.0", "description": "Postprocedural renal failure", "attributes": { "Entity type": "res30: Acute kidney injury", "Category": "diagnostic", "Coding System (ICD-10)": "ICD-10" } }, { "code": "R34", "description": "Anuria and oliguria", "attributes": { "Entity type": "res30: Acute kidney injury", "Category": "diagnostic", "Coding System (ICD-10)": "ICD-10" } }, { "code": "R94.4", "description": "Abnormal results of kidney function studies", "attributes": { "Entity type": "res30: Acute kidney injury", "Category": "diagnostic", "Coding System (ICD-10)": "ICD-10" } } ] } ], "status": 2, "doi": "https://doi.org/10.48533/mqkv-1725", "is_deleted": null, "publish_status": 2, "owner": "ieuan.scanlon", "template": { "id": 1, "name": "Clinical-Coded Phenotype", "description": "Phenotype definitions that are based on lists of clinical codes, or algorithms using clinical codes.", "version_id": 1 }, "versions": [ { "version_id": 1140, "version_name": "Acute Kidney Injury", "version_date": "2021-10-06T16:25:11.671496Z", "is_published": true, "is_latest": true } ] } ]