[ { "phenotype_id": "PH577", "phenotype_version_id": 1154, "name": "Serum creatinine tests", "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": "2021-10-06T16:25:37.205189Z", "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": "2021-10-06T16:25:37.205217Z", "sex": [ { "name": "Both", "value": "3" } ], "type": [ { "name": "Biomarker", "value": "1" } ], "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": "Read codes v2", "value": 5 } ], "event_date_range": "01/04/1997 - 31/03/2014", "concept_information": [ { "concept_id": 1982, "concept_version_id": 5102, "concept_name": "Serum creatinine tests - Primary Care", "coding_system": { "id": 5, "name": "Read codes v2", "description": "Read codes v2" }, "phenotype_id": "PH577", "phenotype_version_id": 1154, "phenotype_name": "Serum creatinine tests", "code_attribute_header": [ "Entity type", "Category", "Coding System (Read)" ], "codes": [ { "code": "4....00", "description": "laboratory procedures", "attributes": { "Entity type": "res30: Serum creatinine tests", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "41...00", "description": "laboratory procedures -general", "attributes": { "Entity type": "res30: Serum creatinine tests", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "4....11", "description": "investigation-laboratory", "attributes": { "Entity type": "res30: Serum creatinine tests", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "4....12", "description": "test - laboratory", "attributes": { "Entity type": "res30: Serum creatinine tests", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "412..00", "description": "laboratory procedure performed", "attributes": { "Entity type": "res30: Serum creatinine tests", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "413..00", "description": "laboratory test requested", "attributes": { "Entity type": "res30: Serum creatinine tests", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "41B..00", "description": "laboratory test due", "attributes": { "Entity type": "res30: Serum creatinine tests", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "41BZ.00", "description": "laboratory test nos due", "attributes": { "Entity type": "res30: Serum creatinine tests", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "41G..00", "description": "laboratory administration procedures", "attributes": { "Entity type": "res30: Serum creatinine tests", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "41G3.00", "description": "specimen received in laboratory", "attributes": { "Entity type": "res30: Serum creatinine tests", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "41H..00", "description": "review of patient laboratory test report", "attributes": { "Entity type": "res30: Serum creatinine tests", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44J..00", "description": "blood urea/renal function", "attributes": { "Entity type": "res30: Serum creatinine tests", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44J3.00", "description": "serum creatinine", "attributes": { "Entity type": "res30: Serum creatinine tests", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44J3000", "description": "serum creatinine abnormal", "attributes": { "Entity type": "res30: Serum creatinine tests", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44J3100", "description": "serum creatinine low", "attributes": { "Entity type": "res30: Serum creatinine tests", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44J3200", "description": "serum creatinine normal", "attributes": { "Entity type": "res30: Serum creatinine tests", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44J3300", "description": "serum creatinine raised", "attributes": { "Entity type": "res30: Serum creatinine tests", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44J3z00", "description": "serum creatinine nos", "attributes": { "Entity type": "res30: Serum creatinine tests", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44JC.00", "description": "corrected plasma creatinine level", "attributes": { "Entity type": "res30: Serum creatinine tests", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44JD.00", "description": "corrected serum creatinine level", "attributes": { "Entity type": "res30: Serum creatinine tests", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44JF.00", "description": "plasma creatinine level", "attributes": { "Entity type": "res30: Serum creatinine tests", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44JZ.00", "description": "blood urea/renal function nos", "attributes": { "Entity type": "res30: Serum creatinine tests", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "451..00", "description": "renal function tests", "attributes": { "Entity type": "res30: Serum creatinine tests", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "4511", "description": "renal function tests normal", "attributes": { "Entity type": "res30: Serum creatinine tests", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "4512", "description": "renal function tests abnormal", "attributes": { "Entity type": "res30: Serum creatinine tests", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "4515", "description": "differential renal function", "attributes": { "Entity type": "res30: Serum creatinine tests", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "4516", "description": "renal function tests borderline", "attributes": { "Entity type": "res30: Serum creatinine tests", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "4519", "description": "deteriorating renal function", "attributes": { "Entity type": "res30: Serum creatinine tests", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "451H.00", "description": "recovery of renal function", "attributes": { "Entity type": "res30: Serum creatinine tests", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "451Z.00", "description": "renal function test nos", "attributes": { "Entity type": "res30: Serum creatinine tests", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "4Q40.00", "description": "creatinine level", "attributes": { "Entity type": "res30: Serum creatinine tests", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "4Z...00", "description": "laboratory procedure nos", "attributes": { "Entity type": "res30: Serum creatinine tests", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "8A6..00", "description": "renal function monitoring", "attributes": { "Entity type": "res30: Serum creatinine tests", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "8H7P.11", "description": "refer to pathology laboratory", "attributes": { "Entity type": "res30: Serum creatinine tests", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "8HP..00", "description": "referral for laboratory tests", "attributes": { "Entity type": "res30: Serum creatinine tests", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "98F..00", "description": "reason for repeat laboratory test", "attributes": { "Entity type": "res30: Serum creatinine tests", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "9b0P.00", "description": "laboratory request", "attributes": { "Entity type": "res30: Serum creatinine tests", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "9b0Q.00", "description": "laboratory result", "attributes": { "Entity type": "res30: Serum creatinine tests", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "9mG..00", "description": "renal function monitoring invitation", "attributes": { "Entity type": "res30: Serum creatinine tests", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "9mG0.00", "description": "renal function monitoring invitation first letter", "attributes": { "Entity type": "res30: Serum creatinine tests", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "9N1Q.00", "description": "seen in diabetic clinic", "attributes": { "Entity type": "res30: Serum creatinine tests", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "C345.00", "description": "gout due to impairment of renal function", "attributes": { "Entity type": "res30: Serum creatinine tests", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "K060.11", "description": "impaired renal function", "attributes": { "Entity type": "res30: Serum creatinine tests", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "K08..00", "description": "impaired renal function disorder", "attributes": { "Entity type": "res30: Serum creatinine tests", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "K08y.00", "description": "other impaired renal function disorder", "attributes": { "Entity type": "res30: Serum creatinine tests", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "K08y300", "description": "renal function impairment with growth failure", "attributes": { "Entity type": "res30: Serum creatinine tests", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "K08yz00", "description": "other impaired renal function disorder nos", "attributes": { "Entity type": "res30: Serum creatinine tests", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "K08z.00", "description": "impaired renal function disorder nos", "attributes": { "Entity type": "res30: Serum creatinine tests", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "R144.00", "description": "[d]renal function test abnormal", "attributes": { "Entity type": "res30: Serum creatinine tests", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "R1yz.11", "description": "[d]unexplained laboratory result", "attributes": { "Entity type": "res30: Serum creatinine tests", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "ZV72600", "description": "[v]laboratory examination", "attributes": { "Entity type": "res30: Serum creatinine tests", "Category": "test", "Coding System (Read)": "Read" } } ] } ], "status": 2, "doi": "https://doi.org/10.48533/kkyd-3q94", "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": 1154, "version_name": "Serum creatinine tests", "version_date": "2021-10-06T16:25:37.234091Z", "is_published": true, "is_latest": true } ] } ]