Angiotensin II Receptor Blocker versus Angiotensin-Converting Enzyme Inhibitor for Postoperative Acute Kidney Injury after Cardiac Surgery

Abstract

Background and aims: Acute Kidney Injury (AKI) after cardiac surgery is a serious complication and a risk factor of postoperative mortality. It has been suggested that Angiotensin Ii Receptor Blockers (ARBs) and Angiotensin- Converting Enzymes (ACE-Is) might be able to reduce the incidence of postoperative AKI after cardiac surgery. However, it remains unknown as to which of these drugs are better for protecting the renal function after cardiac surgery. We hypothesized that each of the ARBs and ACE-Is were able to differentially affect the postoperative AKI after cardiac surgery due to their differential drug efficacies. Thus, this current study investigated the association between the ARBs or ACE-Is and the postoperative AKI after cardiac surgery. Methods: This retrospective single-center observational study was conducted in a community hospital. This study investigated 132 patients undergoing cardiac surgery with cardiopulmonary bypass between January 2013 and December 2015. The association between the incidence of AKI and the usage of ARBs or ACE-Is were analysed by using The Propensity Score Inverse Probability of Treatment Weighting (IPTW) method. Results: Multiple logistic regression analysis after adjustment revealed that of the 132 patients examined, those receiving preoperative ARBs had significantly less incidence of postoperative AKI compared to the other patients (odds ratio [OR], 0.33; 95% confidence interval [CI], 0.11-0.94; P=0.040). However, preoperative administration of ACE-Is were not associated with the incidence of postoperative AKI (OR, 0.73; 95% CI, 0.25-2.17; P=0.58). Conclusions: Our analyses showed that ARBs rather than ACE-Is are potentially the preferable drug for perioperative renal protection. Prospective studies will need to be undertaken in order to elucidate the detailed effects of ARBs and ACE-Is on the kidney after undergoing cardiac surgery.