Skip to main content

Acute kidney injury: an acceptable risk of treatment with renin-angiotensin system blockade in primary care?

Bedford, Michael, Farmer, Christopher K., Irving, Jean, Stevens, Paul E. (2015) Acute kidney injury: an acceptable risk of treatment with renin-angiotensin system blockade in primary care? Canadian Journal of Kidney Health and Disease, 2 (14). E-ISSN 2054-3581. (doi:10.1186/s40697-015-0044-y) (KAR id:52923)

PDF Publisher pdf
Language: English

Creative Commons Licence
This work is licensed under a Creative Commons Attribution 4.0 International License.
Download (425kB) Preview
Official URL



To investigate the association between AKI and use of RAS blockade.


Primary care practices in East and West Kent, United Kingdom.


Demographic, clinical, biochemical and prescription data.


Sufficient serum creatinine data were available to define AKI in 63,735 patients with 208,275 blood test instances. In 95,569 instances the patient was prescribed a RAS antagonist of which 5.4% fulfilled criteria for AKI. The unadjusted odds ratio (OR) for AKI in those prescribed RAS blockade was 1.93 (1.81-2.06, 95%CI) falling to 1.11 (1.02-1.20, 95%CI) when adjusted for age, gender, co-morbidity, GFR category, proteinuria, systolic blood pressure and diuretic therapy. In patients with an evidence-based indication there was no difference in absolute risk of AKI. However, prescription of RAS blockade in the absence of indication appeared to be associated with greater risk of AKI.

When analysis was repeated with AKIN2/AKIN3 as the outcome, although risk of AKI remained significant when unadjusted (OR 1.73, 95%CI 1.42-2.11, p<0.001), after full adjustment there was no increased risk (OR 0.83, 95%CI 0.63-1.09) in those taking RAS antagonists. However, when analysed by indication AKIN2/AKIN3 was significantly more likely in those prescribed RAS antagonists without indication (OR 2.04, 95%CI 1.41-2.94, p<0.001).


Use of RAS antagonists increased the risk of AKI, independent of common confounding variables. After correction for confounders the risk fell away and became non-significant for moderate and severe AKI. However, where there was no evidence-based indication for RAS antagonists the risk of AKI, whether mild, moderate or severe, remained greater.

Item Type: Article
DOI/Identification number: 10.1186/s40697-015-0044-y
Uncontrolled keywords: Acute kidney injury; Renin-angiotensin system blockade; System for Early Identification of Kidney Disease (SEIK)
Subjects: R Medicine > RA Public aspects of medicine
R Medicine > RC Internal medicine
Divisions: Faculties > Social Sciences > School of Social Policy Sociology and Social Research > Centre for Health Services Studies
Depositing User: Christopher Farmer
Date Deposited: 08 Dec 2015 15:05 UTC
Last Modified: 06 Feb 2020 04:13 UTC
Resource URI: (The current URI for this page, for reference purposes)
Farmer, Christopher K.:
  • Depositors only (login required):


Downloads per month over past year