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Acute Kidney Injury

Kethryn E Mansfield, Dorothea Nitsch, Liam Smeeth, Krishnan Bhaskaram, Laurie A Tomlinson

Type
Disease or Syndrome
ID
PH570
Version ID
1140
Valid event data range
01/04/1997 - 31/03/2014
Sex
Female, Male
Agreement Date
2015-12-31
Coding system
ICD10 codes
Tags /Collections
ClinicalCodes Repository Phenotype Library

Definition

Objective:

To investigate whether there is an association between use of ACE inhibitors (ACEI) and angiotensin receptor blockers (ARB), and risk of acute kidney injury (AKI).

Design:

A 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.

Participants:

Adults 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.

Main outcome measures:

Incidence 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.

Results:

Among 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).

Conclusions:

Treatment 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.

Publications

  • Kethryn E Mansfield, Dorothea Nitsch, Liam Smeeth, Krishnan Bhaskaram, Laurie A Tomlinson, Renin-angiostensin system blockage and risk of acute kidney injury. 2015.

Clinical Code List

Rows: 13
Code Description Entity type Category Coding System (ICD-10)
N14 Drug- and heavy-metal-induced tubulo-interstitial and tubular conditions res30: Acute kidney injury diagnostic ICD-10
N14.1 Nephropathy induced by other drugs, medicaments and biological substances res30: Acute kidney injury diagnostic ICD-10
N14.2 Nephropathy induced by unspecified drug, medicament or biological substance res30: Acute kidney injury diagnostic ICD-10
N17 Acute renal failure res30: Acute kidney injury diagnostic ICD-10
N17.0 Acute renal failure with tubular necrosis res30: Acute kidney injury diagnostic ICD-10
N17.1 Acute renal failure with acute cortical necrosis res30: Acute kidney injury diagnostic ICD-10
N17.2 Acute renal failure with medullary necrosis res30: Acute kidney injury diagnostic ICD-10
N17.8 Other acute renal failure res30: Acute kidney injury diagnostic ICD-10
N17.9 Acute renal failure, unspecified res30: Acute kidney injury diagnostic ICD-10
N19 Unspecified kidney failure res30: Acute kidney injury diagnostic ICD-10
N99.0 Postprocedural renal failure res30: Acute kidney injury diagnostic ICD-10
R34 Anuria and oliguria res30: Acute kidney injury diagnostic ICD-10
R94.4 Abnormal results of kidney function studies res30: Acute kidney injury diagnostic ICD-10

API

To Export Phenotype Details:

Format API
XML site_root/api/v1/public/phenotypes/PH570/version/1140/detail/?format=xml
JSON site_root/api/v1/public/phenotypes/PH570/version/1140/detail/?format=json
R Package

# Download here

library(ConceptLibraryClient)


# Connect to API

client = connect_to_API(public=TRUE)


# Get details of phenotype

details = get_phenotype_detail_by_version('PH570', '1140', api_client=client)

To Export Phenotype Code List:

Format API
XML site_root/api/v1/public/phenotypes/PH570/version/1140/export/codes/?format=xml
JSON site_root/api/v1/public/phenotypes/PH570/version/1140/export/codes/?format=json
CSV site_root/phenotypes/PH570/version/1140/export/codes/
R Package

# Download here

library(ConceptLibraryClient)


# Connect to API

client = connect_to_API(public=TRUE)


# Get codelists of phenotype

codelists = get_phenotype_code_list('PH570', '1140', api_client=client)

Version History

Version
ID
Name Owner Publish date
1140 Acute Kidney Injury ieuan.scanlon 2021-10-06 currently shown

Export - export all codes into a csv file/JSON/XML for the current phenotype version.

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