Cardiovascular Drug Use After Acute Kidney Injury Among Hospitalized Patients With a History of Myocardial Infarction

Alejandro Y Meraz-Muñoz; Nivethika Jeyakumar; Bin Luo; William Beaubien-Souligny; Rahul Chanchlani; Edward G Clark; Ziv Harel; Abhijat Kitchlu; Javier A Neyra; Michael Zappitelli; Glenn M Chertow; Amit X Garg; Ron Wald; Samuel A Silver

doi:10.1016/j.ekir.2022.10.027

Cardiovascular Drug Use After Acute Kidney Injury Among Hospitalized Patients With a History of Myocardial Infarction

Kidney Int Rep. 2022 Nov 2;8(2):294-304. doi: 10.1016/j.ekir.2022.10.027. eCollection 2023 Feb.

Authors

Alejandro Y Meraz-Muñoz¹, Nivethika Jeyakumar², Bin Luo², William Beaubien-Souligny³, Rahul Chanchlani^{2

4

5}, Edward G Clark⁶, Ziv Harel^{1

2}, Abhijat Kitchlu^{2

7}, Javier A Neyra⁸, Michael Zappitelli⁹, Glenn M Chertow¹⁰, Amit X Garg^{2

11}, Ron Wald^{1

2}, Samuel A Silver^{2

12}

Affiliations

¹ Division of Nephrology, St. Michael's Hospital, University of Toronto, Ontario, Canada.
² ICES, Toronto, Ontario, Canada.
³ Division of Nephrology, Center Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.
⁴ Division of Pediatric Nephrology, McMaster Children Hospital, McMaster University, Hamilton, Ontario, Canada.
⁵ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
⁶ Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
⁷ Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada.
⁸ Division of Nephrology, Bone and Mineral Metabolism, University of Kentucky, Lexington, Kentucky, USA.
⁹ Division of Pediatric Nephrology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
¹⁰ Division of Nephrology, Stanford University, Palo Alto, California, USA.
¹¹ Division of Nephrology, London Health Sciences Center, Western University, London, Ontario, Canada.
¹² Division of Nephrology, Kingston Health Sciences Center, Queen's University, Kingston, Ontario, Canada.

Abstract

Introduction: Patients who survive acute kidney injury (AKI) may receive fewer cardioprotective drugs. Our objective was to measure the difference in time to dispensing of evidence-based cardiovascular drugs in patients with a history of myocardial infarction (MI) with and without AKI.

Methods: This was a population-based cohort study of patients 66 years of age and older with a history of MI who survived a hospitalization complicated with AKI, propensity-score matched to patients without AKI. The primary outcome was time to outpatient dispensing of an angiotensin-converting enzyme inhibitor (ACEi)/angiotensin II receptor blocker (ARB), statin, or β-blocker within 1 year of hospital discharge.

Results: We identified 28,871 patients with AKI, of whom 21,452 were matched 1:1 to patients without AKI. In the matched cohort, mean age was 80 years, 40% were female, and 34% had an MI during the index hospitalization. AKI was associated with less frequent dispensing of all 3 cardiovascular drug classes within 1 year of hospital discharge (subdistribution hazard ratio [sHR], 0.93; 95% confidence interval [CI], 0.91-0.95). This association was most pronounced in patients with stage 2 (sHR, 0.81; 95% CI, 0.75-0.88) and stage 3 (sHR, 0.71; 95% CI, 0.64-0.79) AKI. We observed less frequent dispensing of statins in patients with stage 2 (sHR, 0.87; 95% CI, 0.81-0.92) and stage 3 (sHR, 0.85; 95% CI, 0.78-0.93) AKI and less frequent dispensing of β-blockers in patients with stage 3 AKI (sHR, 0.86; 95% CI, 0.79-0.94).

Conclusion: In patients with a history of MI, survivors of AKI were less likely to receive prescriptions for ACEi/ARB, statins, or β-blockers within 1 year of hospital discharge. This association was most pronounced in patients with stages 2 and 3 AKI.

Keywords: ACEi; AKI; ARB; MI; ischemic cardiomyopathy.