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Pre- and/or Intra-Operative Prescription of Diuretics, but Not Renin-Angiotensin-System Inhibitors, Is Significantly Associated with Acute Kidney Injury after Non-Cardiac Surgery: A Retrospective Cohort Study.

Tagawa M, Ogata A, Hamano T - PLoS ONE (2015)

Bottom Line: PS adjustment, PS matching, and inverse probability weighting yielded similar results.The effect size of diuretics was significantly greater in the patients with lower propensity for diuretic use (p for interaction < 0.1).Prescription of diuretics, but not ACE-I/ARB, was independently associated with postoperative AKI after non-cardiac surgery, especially in patients with low propensity for diuretic use.

View Article: PubMed Central - PubMed

Affiliation: Department of Nephrology, Kyoto Katsura Hospital, 17 Yamada-hirao-cho, Nishikyo-ku, Kyoto, 6158256, Japan; First Department of Internal Medicine, Nara Medical University, 840 Shijo-cho, Kashihara-shi, Nara, 634-8522, Japan.

ABSTRACT

Background and objectives: Pre- and/or intra-operative use of diuretics, angiotensin-converting enzyme inhibitors (ACE-I) or angiotensin II receptor blockers (ARB) constitutes a potentially modifiable risk factor for postoperative acute kidney injury (AKI). It has been studied whether use of these drugs predicts AKI after cardiac surgery. The objective of this study was to examine whether administration of these agents was independently associated with AKI after non-cardiac surgery.

Design, setting, participants, and measurements: This was a retrospective observational study. Inclusion criteria were adult patients (age ≥ 18) who underwent non-cardiac surgery under general anesthesia from 2007 to 2009 at Kyoto Katsura Hospital. Exclusion criteria were urological surgery, missing creatinine values, and preoperative dialysis. The exposures of interest were pre- and/or intra-operative use of diuretics or ACE-I/ARB. Outcome variables were postoperative AKI as defined by the AKI Network (increase in creatinine ≥ 0.3 mg/dL or 150% within 48 hours, or urine output < 0.5 ml/kg/hour for > 6 hours). Multivariable logistic regression analyses were conducted and adjusted for potential confounders. Propensity scores (PS) for receiving diuretics or ACE-I/ARB therapy were estimated and PS adjustment, PS matching, and inverse probability weighting were performed.

Results: There were 137 AKI cases (5.0%) among 2,725 subjects. After statistical adjustment for patient and surgical characteristics, odds (95% CI) of postoperative AKI were 2.07 (1.10-3.89) (p = 0.02) and 0.89 (0.56-1.42) (p = 0.63) in users of diuretics and ACE-I/ARB, respectively, compared with non-users. PS adjustment, PS matching, and inverse probability weighting yielded similar results. The effect size of diuretics was significantly greater in the patients with lower propensity for diuretic use (p for interaction < 0.1).

Conclusions: Prescription of diuretics, but not ACE-I/ARB, was independently associated with postoperative AKI after non-cardiac surgery, especially in patients with low propensity for diuretic use. It might be reasonable to withhold preoperative diuretics in these patients.

No MeSH data available.


Related in: MedlinePlus

Odds ratio of postoperative acute kidney injury in diuretic user in each quintile of propensity score for diuretic use.p for interaction [PS quintiles * diuretic use] = 0.057<0.1.
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pone.0132507.g001: Odds ratio of postoperative acute kidney injury in diuretic user in each quintile of propensity score for diuretic use.p for interaction [PS quintiles * diuretic use] = 0.057<0.1.

Mentions: To examine whether propensity for diuretic use would affect the effect size of diuretic use, the associations of diuretic use and postoperative AKI were examined in each PS quintile for diuretic use. The use of diuretics was significantly associated with postoperative AKI in the first and second quintiles combined (the first and second quintiles were grouped as the number of outcomes in these quintiles were small) and in the third quintile of PS for diuretic use, but not in other quintiles (Fig 1) (p for interaction [PS quintiles * diuretic use] = 0.057 < 0.1). Thirty-nine patients used ACE-I/ARB and diuretics concomitantly. Pre- and/or intra-operative use of ACE-I/ARB was a significant effect modifier for the association between diuretics use and postoperative AKI (p for interaction [ACE-I/ARB*diuretics] = 0.007). The use of diuretics was significantly associated with postoperative AKI among non-users of ACE-I/ARB but not among users of ACE-I/ARB (Table 4).


Pre- and/or Intra-Operative Prescription of Diuretics, but Not Renin-Angiotensin-System Inhibitors, Is Significantly Associated with Acute Kidney Injury after Non-Cardiac Surgery: A Retrospective Cohort Study.

Tagawa M, Ogata A, Hamano T - PLoS ONE (2015)

Odds ratio of postoperative acute kidney injury in diuretic user in each quintile of propensity score for diuretic use.p for interaction [PS quintiles * diuretic use] = 0.057<0.1.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4492997&req=5

pone.0132507.g001: Odds ratio of postoperative acute kidney injury in diuretic user in each quintile of propensity score for diuretic use.p for interaction [PS quintiles * diuretic use] = 0.057<0.1.
Mentions: To examine whether propensity for diuretic use would affect the effect size of diuretic use, the associations of diuretic use and postoperative AKI were examined in each PS quintile for diuretic use. The use of diuretics was significantly associated with postoperative AKI in the first and second quintiles combined (the first and second quintiles were grouped as the number of outcomes in these quintiles were small) and in the third quintile of PS for diuretic use, but not in other quintiles (Fig 1) (p for interaction [PS quintiles * diuretic use] = 0.057 < 0.1). Thirty-nine patients used ACE-I/ARB and diuretics concomitantly. Pre- and/or intra-operative use of ACE-I/ARB was a significant effect modifier for the association between diuretics use and postoperative AKI (p for interaction [ACE-I/ARB*diuretics] = 0.007). The use of diuretics was significantly associated with postoperative AKI among non-users of ACE-I/ARB but not among users of ACE-I/ARB (Table 4).

Bottom Line: PS adjustment, PS matching, and inverse probability weighting yielded similar results.The effect size of diuretics was significantly greater in the patients with lower propensity for diuretic use (p for interaction < 0.1).Prescription of diuretics, but not ACE-I/ARB, was independently associated with postoperative AKI after non-cardiac surgery, especially in patients with low propensity for diuretic use.

View Article: PubMed Central - PubMed

Affiliation: Department of Nephrology, Kyoto Katsura Hospital, 17 Yamada-hirao-cho, Nishikyo-ku, Kyoto, 6158256, Japan; First Department of Internal Medicine, Nara Medical University, 840 Shijo-cho, Kashihara-shi, Nara, 634-8522, Japan.

ABSTRACT

Background and objectives: Pre- and/or intra-operative use of diuretics, angiotensin-converting enzyme inhibitors (ACE-I) or angiotensin II receptor blockers (ARB) constitutes a potentially modifiable risk factor for postoperative acute kidney injury (AKI). It has been studied whether use of these drugs predicts AKI after cardiac surgery. The objective of this study was to examine whether administration of these agents was independently associated with AKI after non-cardiac surgery.

Design, setting, participants, and measurements: This was a retrospective observational study. Inclusion criteria were adult patients (age ≥ 18) who underwent non-cardiac surgery under general anesthesia from 2007 to 2009 at Kyoto Katsura Hospital. Exclusion criteria were urological surgery, missing creatinine values, and preoperative dialysis. The exposures of interest were pre- and/or intra-operative use of diuretics or ACE-I/ARB. Outcome variables were postoperative AKI as defined by the AKI Network (increase in creatinine ≥ 0.3 mg/dL or 150% within 48 hours, or urine output < 0.5 ml/kg/hour for > 6 hours). Multivariable logistic regression analyses were conducted and adjusted for potential confounders. Propensity scores (PS) for receiving diuretics or ACE-I/ARB therapy were estimated and PS adjustment, PS matching, and inverse probability weighting were performed.

Results: There were 137 AKI cases (5.0%) among 2,725 subjects. After statistical adjustment for patient and surgical characteristics, odds (95% CI) of postoperative AKI were 2.07 (1.10-3.89) (p = 0.02) and 0.89 (0.56-1.42) (p = 0.63) in users of diuretics and ACE-I/ARB, respectively, compared with non-users. PS adjustment, PS matching, and inverse probability weighting yielded similar results. The effect size of diuretics was significantly greater in the patients with lower propensity for diuretic use (p for interaction < 0.1).

Conclusions: Prescription of diuretics, but not ACE-I/ARB, was independently associated with postoperative AKI after non-cardiac surgery, especially in patients with low propensity for diuretic use. It might be reasonable to withhold preoperative diuretics in these patients.

No MeSH data available.


Related in: MedlinePlus