Phenotype Library | phenotype: Acute Kidney Injury

Acute Kidney Injury

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

Type

Disease or Syndrome

PH570

Version ID

1140

Data Sources

HES Admitted Patient Care data for CPRD GOLD

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

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C1969/5076 Acute Kidney Injury - Primary Care - ICD10 codes

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