Impact of contrast-induced acute kidney injury on the association between renin-angiotensin system inhibitors and long-term mortality in heart failure patients

• Main Authors: Li Lei, Yulu Huang, Zhaodong Guo, Feier Song, Yibo He, Jin Liu, Guoli Sun, Bowen Liu, Pengyuan Chen, Jianbin Zhao, Dengxuan Wu, Yan Xue, Wenhe Yan, Zefeng Lin, Xiuqiong Huang, Guanzhong Chen, Shiqun Chen, Yong Liu, Jiyan Chen
• Format: Article
• Language: English
• Published: Hindawi - SAGE Publishing 2020-12-01
• Series: Journal of the Renin-Angiotensin-Aldosterone System
• Online Access: https://doi.org/10.1177/1470320320979795

Introduction: Renin-angiotensin system inhibitors (RASi) reduce mortality among heart failure (HF) patients, but their effect among those complicating contrast-induced acute kidney injury (CI-AKI) remains unexplored. We aimed to investigate whether the relationship between RASi prescription at discharge and mortality differs between HF patients with or without CI-AKI following coronary angiography (CAG). Methods: About 596 HF patients from an observational cohort were divided into a CI-AKI group ( n  = 104) and a non-CI-AKI group ( n  = 492) based on whether they had CI-AKI following CAG. The endpoint was all-cause mortality. Multivariable Cox regression was performed in each group to explore the associations between RASi at discharge and mortality. Results: During the median follow-up time of 2.26 (1.70; 3.24) years, higher mortality rate was observed in the CI-AKI group compared to the non-CI-AKI group (18.3% vs 8.9%, p  = 0.002). Among HF patients with CI-AKI, after adjusting for confounding factors, the association was not significant between RASi prescription at discharge and mortality (HR: 0.39, 95%CI: 0.12–1.31, p  = 0.128), while it was among those without CI-AKI (HR: 0.39, 95%CI: 0.18–0.84, p  = 0.016). Conclusion: RASi prescription at discharge for HF patients complicating CI-AKI tended to be ineffective, while it benefited those without CI-AKI. Further randomized evidence is needed to confirm this trend.