Journal article
The impacts of angiotensin converting enzyme inhibitors and angiotensin receptor blockers on rates of acute kidney injury in hospitalized adults receiving multiple nephrotoxins
BMC nephrology
03/26/2026
DOI: 10.1186/s12882-026-04884-3
PMID: 41888719
Abstract
Discontinuation of angiotensin converting enzyme inhibitors and angiotensin receptor blockers (ACEI/ARBs) is a common component of many nephrotoxin-associated acute kidney injury (NA-AKI) prevention strategies, though their intrinsic nephrotoxic potential has been increasingly challenged. We hypothesized that ACEI/ARBs would associate with increased overall AKI and stage 2/3 AKI in hospitalized adults receiving multiple nephrotoxins.
This retrospective cohort study included adult patients admitted to the University of Iowa Hospital for ≥ 3 days from 2014 to 2022. We compared patients receiving 2 nephrotoxins to patients receiving 3, with one being an ACEI/ARB. This allowed us to compare patients not counted as having a high nephrotoxin exposure to a group that would due to an additional ACEI/ARB. The primary outcome was AKI within 7 days of initial exposure. Secondary outcomes included stage 2/3 AKI and AKI occurring within 3 and 14 days of initial exposure. Generalized estimating equations with robust standard errors were used to estimate associations and incorporated inverse probability of treatment weighting (IPTW) based on 30 clinical covariates.
The primary analysis included 15,438 patients exposed to two non-ACEI/ARB nephrotoxins, of which 1,106 (7.2%) also received an ACEI/ARB. Groups were well-matched after IPTW. Adjusted risk of AKI was 25% (95% CI 22-29%) in the ACEI/ARB group, and 20% (19-21%) in the comparator group (adjusted odds ratio 1.35, 95% CI 1.07-1.71). In contrast, ACEI/ARB exposure was not associated with increased risk of stage 2/3 AKI.
In a cohort of hospitalized patients receiving multiple nephrotoxic agents, ACEI/ARBs were associated with higher risks of AKI, but not higher rates of stage 2/3 AKI.
Details
- Title: Subtitle
- The impacts of angiotensin converting enzyme inhibitors and angiotensin receptor blockers on rates of acute kidney injury in hospitalized adults receiving multiple nephrotoxins
- Creators
- Michael Tabet - University of IowaMary Vaughan-Sarrazin - University of Iowa, General Internal MedicineBrian C Lund - University of IowaSpyridon Fortis - University of IowaDiana Jalal - University of IowaJason Misurac - University of IowaBenjamin R Griffin - Center for Access & Delivery Research and Evaluation (CADRE), Iowa City Veterans' Affairs Health Care System, Iowa City, IA, USA. Benjamin-griffin@uiowa.edu
- Resource Type
- Journal article
- Publication Details
- BMC nephrology
- DOI
- 10.1186/s12882-026-04884-3
- PMID
- 41888719
- NLM abbreviation
- BMC Nephrol
- ISSN
- 1471-2369
- eISSN
- 1471-2369
- Publisher
- Springer
- Grant note
- 1IK2BX006525-01A1 / U.S. Department of Veterans Affairs HX0003533-01A1 / U.S. Department of Veterans Affairs,United States
- Language
- English
- Electronic publication date
- 03/26/2026
- Academic Unit
- Pulmonary, Critical Care, and Occupational Medicine; Nephrology, Dialysis and Transplantation; Health Management and Policy; Stead Family Department of Pediatrics; Epidemiology; Nephrology; General Internal Medicine; Internal Medicine
- Record Identifier
- 9985149413202771
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