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.
Kethryn E Mansfield, Dorothea Nitsch, Liam Smeeth, Krishnan Bhaskaram, Laurie A Tomlinson, Renin-angiostensin system blockage and risk of acute kidney injury. 2015.
Code | Description | Entity type | Category | Coding System (ICD-10 Read) |
---|---|---|---|---|
14AN.00 | h/o: atrial fibrillation | res30: Arrhythmia | diagnostic | Read |
14AR.00 | history of atrial flutter | res30: Arrhythmia | diagnostic | Read |
212R.00 | atrial fibrillation resolved | res30: Arrhythmia | diagnostic | Read |
327..00 | ecg: supraventricular arrhythmia | res30: Arrhythmia | diagnostic | Read |
3272 | ecg: atrial fibrillation | res30: Arrhythmia | diagnostic | Read |
3273 | ecg: atrial flutter | res30: Arrhythmia | diagnostic | Read |
328..00 | ecg: ventricular arrhythmia | res30: Arrhythmia | diagnostic | Read |
3282 | ecg: ventricular tachycardia | res30: Arrhythmia | diagnostic | Read |
328Z.00 | ecg: ventricular arrhythmia nos | res30: Arrhythmia | diagnostic | Read |
662S.00 | atrial fibrillation monitoring | res30: Arrhythmia | diagnostic | Read |
6A9..00 | atrial fibrillation annual review | res30: Arrhythmia | diagnostic | Read |
7936A00 | implant intravenous pacemaker for atrial fibrillation | res30: Arrhythmia | diagnostic | Read |
8CMW200 | atrial fibrillation care pathway | res30: Arrhythmia | diagnostic | Read |
8HTy.00 | referral to atrial fibrillation clinic | res30: Arrhythmia | diagnostic | Read |
9Os..00 | atrial fibrillation monitoring administration | res30: Arrhythmia | diagnostic | Read |
9Os0.00 | atrial fibrillation monitoring first letter | res30: Arrhythmia | diagnostic | Read |
9Os1.00 | atrial fibrillation monitoring second letter | res30: Arrhythmia | diagnostic | Read |
9Os2.00 | atrial fibrillation monitoring third letter | res30: Arrhythmia | diagnostic | Read |
9Os3.00 | atrial fibrillation monitoring verbal invite | res30: Arrhythmia | diagnostic | Read |
9Os4.00 | atrial fibrillation monitoring telephone invite | res30: Arrhythmia | diagnostic | Read |
9hF..00 | exception reporting: atrial fibrillation quality indicators | res30: Arrhythmia | diagnostic | Read |
9hF1.00 | excepted from atrial fibrillation qual indic: inform dissent | res30: Arrhythmia | diagnostic | Read |
G559.00 | arrhythmogenic right ventricular cardiomyopathy | res30: Arrhythmia | diagnostic | Read |
G55A.11 | tachycardia-induced cardiomyopathy | res30: Arrhythmia | diagnostic | Read |
G56..00 | conduction disorders | res30: Arrhythmia | diagnostic | Read |
G56..11 | conduction disorders of heart | res30: Arrhythmia | diagnostic | Read |
G567400 | wolff-parkinson-white syndrome | res30: Arrhythmia | diagnostic | Read |
G56y.00 | other conduction disorders | res30: Arrhythmia | diagnostic | Read |
G56y000 | lown-ganong-levine syndrome | res30: Arrhythmia | diagnostic | Read |
G56zz00 | conduction disorders nos | res30: Arrhythmia | diagnostic | Read |
G57..00 | cardiac dysrhythmias | res30: Arrhythmia | diagnostic | Read |
G57..11 | cardiac arrhythmias | res30: Arrhythmia | diagnostic | Read |
G570.00 | paroxysmal supraventricular tachycardia | res30: Arrhythmia | diagnostic | Read |
G570000 | paroxysmal atrial tachycardia | res30: Arrhythmia | diagnostic | Read |
G570100 | paroxysmal atrioventricular tachycardia | res30: Arrhythmia | diagnostic | Read |
G570200 | paroxysmal junctional tachycardia | res30: Arrhythmia | diagnostic | Read |
G570300 | paroxysmal nodal tachycardia | res30: Arrhythmia | diagnostic | Read |
G570z00 | paroxysmal supraventricular tachycardia nos | res30: Arrhythmia | diagnostic | Read |
G571.00 | paroxysmal ventricular tachycardia | res30: Arrhythmia | diagnostic | Read |
G571.11 | ventricular tachycardia | res30: Arrhythmia | diagnostic | Read |
G572.00 | paroxysmal tachycardia unspecified | res30: Arrhythmia | diagnostic | Read |
G572000 | essential paroxysmal tachycardia | res30: Arrhythmia | diagnostic | Read |
G572z00 | paroxysmal tachycardia nos | res30: Arrhythmia | diagnostic | Read |
G573.00 | atrial fibrillation and flutter | res30: Arrhythmia | diagnostic | Read |
G573000 | atrial fibrillation | res30: Arrhythmia | diagnostic | Read |
G573100 | atrial flutter | res30: Arrhythmia | diagnostic | Read |
G573200 | paroxysmal atrial fibrillation | res30: Arrhythmia | diagnostic | Read |
G573300 | non-rheumatic atrial fibrillation | res30: Arrhythmia | diagnostic | Read |
G573400 | permanent atrial fibrillation | res30: Arrhythmia | diagnostic | Read |
G573500 | persistent atrial fibrillation | res30: Arrhythmia | diagnostic | Read |
G573600 | paroxysmal atrial flutter | res30: Arrhythmia | diagnostic | Read |
G573z00 | atrial fibrillation and flutter nos | res30: Arrhythmia | diagnostic | Read |
G574.00 | ventricular fibrillation and flutter | res30: Arrhythmia | diagnostic | Read |
G574100 | ventricular flutter | res30: Arrhythmia | diagnostic | Read |
G574z00 | ventricular fibrillation and flutter nos | res30: Arrhythmia | diagnostic | Read |
G576300 | atrial premature depolarization | res30: Arrhythmia | diagnostic | Read |
G576400 | junctional premature depolarization | res30: Arrhythmia | diagnostic | Read |
G576500 | ventricular premature depolarization | res30: Arrhythmia | diagnostic | Read |
G57y.00 | other cardiac dysrhythmias | res30: Arrhythmia | diagnostic | Read |
G57y600 | nodal rhythm disorder | res30: Arrhythmia | diagnostic | Read |
G57y900 | supraventricular tachycardia nos | res30: Arrhythmia | diagnostic | Read |
G57yA00 | re-entry ventricular arrhythmia | res30: Arrhythmia | diagnostic | Read |
G57yz00 | other cardiac dysrhythmia nos | res30: Arrhythmia | diagnostic | Read |
G57z.00 | cardiac dysrhythmia nos | res30: Arrhythmia | diagnostic | Read |
Gyu5a00 | [x]other specified cardiac arrhythmias | res30: Arrhythmia | diagnostic | Read |
Code | Description | Entity type | Category | Coding System (ICD-10 Read) |
---|---|---|---|---|
I45.6 | pre-excitation syndrome | res30: Arrhythmia | diagnostic | ICD-10 |
I47 | paroxysmal tachycardia | res30: Arrhythmia | diagnostic | ICD-10 |
I47.0 | re-entry ventricular arrhythmia | res30: Arrhythmia | diagnostic | ICD-10 |
I47.1 | supraventricular tachycardia | res30: Arrhythmia | diagnostic | ICD-10 |
I47.2 | ventricular tachycardia | res30: Arrhythmia | diagnostic | ICD-10 |
I47.9 | paroxysmal tachycardia, unspecified | res30: Arrhythmia | diagnostic | ICD-10 |
I48 | atrial fibrillation and flutter | res30: Arrhythmia | diagnostic | ICD-10 |
I49 | other cardiac arrhythmias | res30: Arrhythmia | diagnostic | ICD-10 |
I49.0 | ventricular fibrillation and flutter | res30: Arrhythmia | diagnostic | ICD-10 |
I49.1 | atrial premature depolarization | res30: Arrhythmia | diagnostic | ICD-10 |
I49.2 | junctional premature depolarization | res30: Arrhythmia | diagnostic | ICD-10 |
I49.3 | ventricular premature depolarization | res30: Arrhythmia | diagnostic | ICD-10 |
I49.4 | other and unspecified premature depolarization | res30: Arrhythmia | diagnostic | ICD-10 |
I49.5 | sick sinus syndrome | res30: Arrhythmia | diagnostic | ICD-10 |
R00.0 | tachycardia, unspecified | res30: Arrhythmia | diagnostic | ICD-10 |
To Export Phenotype Details:
Format | API |
---|---|
XML | site_root/api/v1/public/phenotypes/PH571/version/1142/detail/?format=xml |
JSON | site_root/api/v1/public/phenotypes/PH571/version/1142/detail/?format=json |
R Package |
|
To Export Phenotype Code List:
Format | API |
---|---|
XML | site_root/api/v1/public/phenotypes/PH571/version/1142/export/codes/?format=xml |
JSON | site_root/api/v1/public/phenotypes/PH571/version/1142/export/codes/?format=json |
CSV | site_root/phenotypes/PH571/version/1142/export/codes/ |
R Package |
|
Version ID |
Name | Owner | Publish date | |
---|---|---|---|---|
1142 | Arrhythmia | 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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