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Sunchit Madan, Patrick A. Norman, Ron Wald, Javier A. Neyra, Alejandro Meraz-Muñoz, Ziv Harel, Samuel A. Silver

Jun 14, 2022
Canadian Journal of Kidney Health and Disease

Canadian Journal of Kidney Health and Disease, Volume 9, Issue , January December 2022.
Background : Survivors of acute kidney injury (AKI) are at a high risk for cardiovascular complications. An underrecognition of this risk may contribute to the low utilization of relevant guideline based therapies in this population.
Objective : We sought to assess accordance with guideline based recommendations for survivors of AKI with diabetes, coronary artery disease (CAD), and preexisting chronic kidney disease (CKD) in a post AKI clinic, and identify factors that may be associated with guideline accordance.
Design : Retrospective cohort study. Setting: Post AKI clinics at 2 tertiary care centers in Ontario, Canada. Patients: We included adult patients seen in both post AKI clinics between 2013 and 2019 who had at least 2 clinic visits within 24 months of an index AKI hospitalization. Measurements: We assessed accordance to recommendations from the most recent North American and international guidelines available at the time of study completion for diabetes, CAD, and CKD.
Method : We compared guideline accordance between visits using the Cochran Mantel Haenszel test. We used multivariable Poisson regression to identify prespecified factors associated with accordance.
Result : Of 213 eligible patients, 192 (90%) had Kidney Disease Improving Global Outcomes Stage 2 3 AKI, 91 (43%) had diabetes, 76 (36%) had CAD, and 88 (41%) had preexisting CKD. From the first clinic visit to the second, there was an increase in angiotensin converting enzyme inhibitor/angiotensin receptor blocker (ACE I/ARB) use across all disease groups—from 33% to 46% (P = .028) in patients with diabetes, from 30% to 57% (P = .002) in patients with CAD, and from 16% to 35% (P < .001) in patients with preexisting CKD. Statin use increased in patients with preexisting CKD from 64% to 71% (P = .034). Every 25 μmol/L rise in the discharge serum creatinine was associated with a 19% (95% confidence interval , 8% 28%) and 12% (95% CI, 2% 21%) lower likelihood of being on an ACE I/ARB in patients with diabetes and preexisting CKD, respectively. Limitations: The study lacked a comparison group that received usual care. The small sample and multiple comparisons make false positives possible.
Conclusion : There is room to improve guideline based cardiovascular risk factor management in survivors of AKI, particularly ACE I/ARB use in patients with an elevated discharge serum creatinine.

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