DataSheet1_The Impact of Angiotensin-Converting Enzyme Inhibitors or Angiotensin II Receptor Blockers on Clinical Outcomes of Acute Kidney Disease Patients: A Systematic Review and Meta-Analysis.docx

Background: Acute kidney injury (AKI) may increase the risk of chronic kidney disease (CKD), development of end-stage renal disease (ESRD), and mortality. However, the impact of exposure to angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker (ACEi/ARB) in patients experiencing AKI/acute kidney disease (AKD) is still unclear.Methods: In this systematic review, we searched all relevant studies from PubMed, Embase, Cochrane, Medline, Collaboration Central Register of Controlled Clinical Trials, Cochrane Systematic Reviews, and ClinicalTrials.gov until July 21, 2020. We evaluated whether the exposure to ACEi/ARB after AKI onset alters recovery paths of AKD and impacts risks of all-cause mortality, recurrent AKI, or incident CKD. We rated the certainty of evidence according to Cochrane methods and the GRADE approach.Results: A total of seven articles, involving 70,801 patients, were included in this meta-analysis. The overall patient mortality rate in this meta-analysis was 28.4%. Among AKI patients, all-cause mortality was lower in ACEi/ARB users than in ACEi/ARB nonusers (log odds ratio (OR) −0.37, 95% confidence interval (CI): −0.42–−0.32, p < 0.01). The risk of recurrent adverse kidney events after AKI was lower in ACEi/ARB users than in nonusers (logOR −0.25, 95% CI: −0.33–−0.18, p < 0.01). The risk of hyperkalemia was higher in ACEi/ARB users than in nonusers (logOR 0.43, 95% CI: 0.27–0.59, p < 0.01). Patients with continued use of ACEi/ARB after AKI also had lower mortality risk than those prior ACEi/ARB users but who did not resume ACEi/ARB during AKD (logOR −0.36, 95% CI: −0.4–−0.31, p < 0.01).Conclusions: Exposure to ACEi/ARB after AKI is associated with lower risks of all-cause mortality, recurrent AKI, and progression to incident CKD. Patients with AKI may have a survival benefit by continued use of ACEi/ARB; however, a higher incidence of hyperkalemia associated with ACEi/ARB usage among these patients deserves close clinical monitoring.

背景：急性肾损伤（AKI）可能增加慢性肾脏病（CKD）、终末期肾病（ESRD）的发生风险以及死亡率。然而，对于经历AKI/急性肾脏疾病（AKD）的患者而言，接触血管紧张素转换酶抑制剂或血管紧张素II受体阻滞剂（ACEi/ARB）的影响尚不明确。方法：在本系统性综述中，我们检索了截至2020年7月21日PubMed、Embase、Cochrane、Medline、协作中央临床试验注册处、Cochrane系统性综述和ClinicalTrials.gov上的所有相关研究。我们评估了AKI发生后接触ACEi/ARB是否改变了AKD的康复路径，并对其总死亡率、复发AKI或新发CKD的风险产生了影响。我们根据Cochrane方法和GRADE方法对证据的确定性进行了评估。结果：本荟萃分析共纳入7篇文章，涉及70,801名患者。本荟萃分析中的总体患者死亡率率为28.4%。在AKI患者中，与未使用ACEi/ARB的患者相比，使用ACEi/ARB的患者全因死亡率较低（对数比数比（OR）-0.37，95%置信区间（CI）：-0.42至-0.32，p < 0.01）。与未使用ACEi/ARB的患者相比，使用ACEi/ARB的患者在AKI后复发不良肾脏事件的风险较低（对数OR -0.25，95% CI：-0.33至-0.18，p < 0.01）。与未使用ACEi/ARB的患者相比，使用ACEi/ARB的患者高钾血症的风险较高（对数OR 0.43，95% CI：0.27至0.59，p < 0.01）。在AKI后继续使用ACEi/ARB的患者与之前使用过ACEi/ARB但未在AKD期间重新开始使用ACEi/ARB的患者相比，死亡率风险较低（对数OR -0.36，95% CI：-0.4至-0.31，p < 0.01）。结论：AKI后接触ACEi/ARB与全因死亡率、复发AKI以及进展为CKD的风险降低相关。AKI患者通过持续使用ACEi/ARB可能获得生存益处；然而，这些患者中与ACEi/ARB使用相关的高钾血症发生率较高，值得临床密切监测。