Association between dose reduction of renin-angiotensin-aldosterone system inhibitors before coronary artery angiography and acute kidney injury: a propensity score-matched study

Abstract

Objective

The aim of this study was to investigate the association between dose reduction of renin-angiotensin-aldosterone system inhibitors (RAASis) and Acute kidney injury (AKI). AKI, which is commonly observed in hospitalized patients, increases mortality. Although RAASis and coronary artery angiography (CAG) are reported to be risk factors for AKI, whether dose reduction of RAASis can prevent AKI after CAG remains unknown.

Methods

In this retrospective propensity score (PS)-matched cohort from the RWD database, which includes 20 million patients from 190 hospitals in Japan, we examined the impact of dose reduction of RAASis on the development of AKI after CAG. The subjects were patients with an estimated glomerular filtration rate (eGFR) of 15–60 mL/min/1.73 m², and the exposure of interest was the presence of a dose reduction in RAASis within 3 days before CAG was performed. Propensity score matching was performed with 19 baseline characteristics using a logistic regression model.

Results

We identified 3329 patients who were prescribed RAASis at least one month before admission and underwent CAG. Six hundred seventy-four patients had a dose reduction 3 days prior to undergoing CAG, and 2655 patients did not. AKI was observed in 34 (5.0%) patients in the reduction group and 137 (5.2%) patients in the control group. There was no significant difference in the primary outcome between the two groups in the PS-matched cohort (OR: 1.08, 95% CI: 0.70–1.66).

Conclusions

A reduction in the dose of RAASis did not prevent the development of AKI among patients undergoing CAG.

Keywords:

• AKI
• contrast-induced nephropathy
• contrast media
• coronary artery angiography
• RAAS inhibitor

Trial registration:

• R000057896

Transparency

Declaration of funding

This work was supported by a Grant-in-Aid for Scientific Research from the Japan Society for the Promotion of Science [grant number: 20H03941].

Declaration of financial/other relationships

Koji Kawakami has received research funds from Eisai Co., Ltd., Kyowa Kirin Co., Ltd., Sumitomo Pharma Co., Ltd., Mitsubishi Corporation, and Real World Data Co., Ltd.; consulting fees from LEBER Inc., JMDC Inc., Shin Nippon Biomedical Laboratories Ltd., and Advanced Medical Care Inc.; executive compensation from Cancer Intelligence Care Systems, Inc.; and honoraria from Mitsubishi Corporation, Pharma Business Academy, and Toppan Inc. The other authors have no conflicts of interest to declare. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

H.H. conducted the analysis and wrote the first draft of the manuscript. M.T. redrafted the manuscript and commented on the analysis. K.K. advised on the study design and analysis.

Acknowledgements

Not applicable.

Data availability statement

Data sharing is not permitted under HCEI policy. Readers who are interested in our dataset can contact HCEI for data availability (https://www.hcei.or.jp).