Risk factors associated with biochemically detected and hospitalised acute kidney injury in patients prescribed renin angiotensin system inhibitors

Patrick B. Mark* (Corresponding Author), Richard Papworth, Nitish Ramparsad, Laurie Tomlinson, Simon Sawhney, Corri Black, Alex McConnachie, Colin McCowan

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)
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Aims Therapy with angiotensin converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) is a mainstay of treatment for heart failure (HF), diabetes mellitus (DM) and chronic kidney disease (CKD). These agents have been associated with development of acute kidney injury (AKI) during intercurrent illness. Risk factors for AKI in patients prescribed ACEi/ARB therapy are not well described.
Methods We the incidence of AKI in patients commencing ACEi/ARB during 2009‐2015 using anonymised patient records. Hospital‐coded AKI was defined from hospital episode statistics; biochemical AKI was ascertained from laboratory data. Risk factors for biochemically detected and hospitalised AKI were investigated.
Results Of 61,318 patients prescribed ACEi/ARB, with 132,885 person years (py) follow up, there were 1,070 hospitalisations with AKI as a diagnoses recorded and a total of 4,645 AKI events, including AKI episodes indicated by biochemical KDIGO‐based creatinine change criteria. Incidence of any AKI event was 35.0 per 1000‐ py, hospital‐coded AKI was 7.8 per 1000‐py and biochemical AKI was 33.7 per 1000‐py. Independent risk factors in a multivariable model for hospital‐coded AKI events were age, male gender, HF, diabetes, cerebrovascular disease, lower estimated glomerular filtration rate, socioeconomic deprivation, diuretic or non‐steroidal anti‐inflammatory use (all p<0.001).
Conclusion In patients prescribed ACEi/ARB, the highest risk of AKI is associated with conditions which are considered strong evidence‐based indications for their prescription. Socio‐economic status is an under‐reported risk factor for AKI with these agents. Strategies targeted at prevention of AKI may be of benefit, such as enhanced awareness based on higher risk comorbidities.
Original languageEnglish
Pages (from-to)121-131
Number of pages11
JournalBritish Journal of Clinical Pharmacology
Issue number1
Early online date3 Jan 2020
Publication statusPublished - Jan 2020

Bibliographical note

Acknowledgments: The authors would like to thank Claire MacDonald from NHS Greater Glasgow and Clyde Safe Haven for technical assistance with the project.

Funding: This work was funded by the Chief Scientist Office Scotland (grant HICG/1/1)


  • acute kidney injury
  • angiotensin converting enzyme inhibitor
  • angiotensin receptor blocker
  • heart failure
  • chronic kidney disease


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