Table1_Angiotensin II Receptor Blocker Associated With Less Outcome Risk in Patients With Acute Kidney Disease.docx

Objective: The aim of this study was to explore the respective use of angiotensin-converting-enzyme inhibitors (ACEis) or angiotensin receptor blockers (ARBs) on the outcomes of patients who could be weaned from dialysis-requiring acute kidney injury (AKI-D).Methods: This case–control study enrolled 41,731 patients who were weaned from AKI-D for at least 7 days from Taiwan’s National Health Insurance Administration. We further grouped AKI-D patients according to ACEi and ARB use to evaluate subsequent risks of all-cause mortality and re-dialysis. The outcomes included the all-cause mortality and new-onset of end-stage kidney disease (ESKD; re-dialysis) following withdraw from AKI-D.Results: A total of 17,141 (41.1%) patients surviving AKI-D could be weaned from dialysis for at least 7 days. The overall events of mortality were 366 (48.9%) in ACEi users, 659 (52.1%) in ARB users, and 6,261 (41.3%) in ACEi/ARB nonusers, during a mean follow-up period of 1.01 years after weaning from AKI-D. In regard to all-cause of mortality, pre-dialysis ARB users had lower incidence than ACEi users [hazard ratio (HR 0.82), p = 0.017]. Compared with ACEi/ARB nonusers, continuing ARB users had a significantly low risk of long-term all-cause mortality (adjusted hazard ratio 0.51, p = 0.013) after propensity score matching. However, new users of ACEi at the acute kidney disease (AKD) period had a higher risk of re-dialysis after weaning than ACEi/ARB nonusers (aHR 1.82, p Conclusions: Compared with patients without ACEi/ARB, those continuing to use ARB before the event and after weaning had low all-cause mortality, while new users of ACEi at AKD had increased risk of re-dialysis. AKI-D patients continuing to use ACEi or ARB did not have higher risk of hyperkalemia. Future prospective randomized trials are expected to confirm these findings.</p

Image1_Angiotensin II Receptor Blocker Associated With Less Outcome Risk in Patients With Acute Kidney Disease.pdf

Objective: The aim of this study was to explore the respective use of angiotensin-converting-enzyme inhibitors (ACEis) or angiotensin receptor blockers (ARBs) on the outcomes of patients who could be weaned from dialysis-requiring acute kidney injury (AKI-D).Methods: This case–control study enrolled 41,731 patients who were weaned from AKI-D for at least 7 days from Taiwan’s National Health Insurance Administration. We further grouped AKI-D patients according to ACEi and ARB use to evaluate subsequent risks of all-cause mortality and re-dialysis. The outcomes included the all-cause mortality and new-onset of end-stage kidney disease (ESKD; re-dialysis) following withdraw from AKI-D.Results: A total of 17,141 (41.1%) patients surviving AKI-D could be weaned from dialysis for at least 7 days. The overall events of mortality were 366 (48.9%) in ACEi users, 659 (52.1%) in ARB users, and 6,261 (41.3%) in ACEi/ARB nonusers, during a mean follow-up period of 1.01 years after weaning from AKI-D. In regard to all-cause of mortality, pre-dialysis ARB users had lower incidence than ACEi users [hazard ratio (HR 0.82), p = 0.017]. Compared with ACEi/ARB nonusers, continuing ARB users had a significantly low risk of long-term all-cause mortality (adjusted hazard ratio 0.51, p = 0.013) after propensity score matching. However, new users of ACEi at the acute kidney disease (AKD) period had a higher risk of re-dialysis after weaning than ACEi/ARB nonusers (aHR 1.82, p Conclusions: Compared with patients without ACEi/ARB, those continuing to use ARB before the event and after weaning had low all-cause mortality, while new users of ACEi at AKD had increased risk of re-dialysis. AKI-D patients continuing to use ACEi or ARB did not have higher risk of hyperkalemia. Future prospective randomized trials are expected to confirm these findings.</p

Histogram and density plot of visual analogue scale (VAS) change scores.

<p>Frequency distribution of pruritus VAS change scores in the study participants. The density of vertical axis represents the percentage of study participants. The VAS change score = VAS score at follow-up − VAS score at baseline.</p

Additional file 1 of Comparative accuracy of biomarkers for the prediction of hospital-acquired acute kidney injury: a systematic review and meta-analysis

Additional file 1: Supplementary appendix

Laboratory and clinical characteristics of participants with improved and unimproved pruritus intensity, at baseline and at follow-up.

<p>NOTE. Data are expressed as mean ± S.D for normally distributed continuous variables; as median (interquartile range) for non-normally distributed continuous variables; and as number (percentage) for categorical variables.</p><p>Abbreviations: VAS, visual analog scale.</p>*<p><i>P</i><0.05 for the statistical testing between participants with improved pruritus and those with unimproved pruritus.</p>**<p>Ca×P = Product of albumin-adjusted serum calcium (Ca) and serum phosphorus (P).</p

Identifying the appropriate threshold of baseline Kt/V by the generalized additive models (GAM) plot.

<p>(A) The GAM plot adjusted for the important covariates at baseline only (gender, Kt/V, use of high-flux dialyzer, pruritus intensity, hematocrit, creatinine, uric acid, fasting glucose, total bilirubin, and Ca×P).(B) The GAM plot adjusted for the important covariates at baseline (Kt/V, pruritus intensity, AST, and Ca×P) and the change scores of the covariates (uric acid, fasting glucose, and AST). The solid red lines show nonlinearity of multivariable-adjusted relation between baseline Kt/V and change score of pruritus (with 95% confidence intervals shown in black dotted lines). Pruritus intensity was assessed by visual analog scale scores. The little vertical bars (i.e., rugs) on the horizontal axis of the GAM plots display the distribution of individual observations. Both GAM plots identified the value around 1.5 to be the appropriate threshold of baseline Kt/V for uremic pruritus, which indicated start of the aggravation of pruritus intensity began at Kt/V <1.5.</p

Laboratory and clinical characteristics of participants at baseline and follow-up.

<p>NOTE. Data are expressed as mean ± S.D for normally distributed continuous variables; as median (interquartile range) for non-normally distributed continuous variables; and as number (percentage) for categorical variables.</p><p>Abbreviations: VAS, visual analog scale.</p>*<p><i>P</i><0.05 for the statistical testing between baseline and follow-up.</p>**<p>Ca×P = Product of albumin-adjusted serum calcium (Ca) and serum phosphorus (P).</p

Histogram and density plot of visual analogue scale (VAS) scores.

<p>(A) Frequency distribution of pruritus VAS scores at baseline in the study participants. (B) Frequency distribution of pruritus VAS scores at follow-up in the study participants. The density of vertical axis represents the percentage of study participants.</p

Demographic and clinical characteristics of participants at baseline.

<p>NOTE. Data are expressed as mean ± S.D. or number (percentage).</p

Linear regression analysis of the predictors associated with the change score of pruritus intensity with dichotomized baseline Kt/V at its appropriate threshold value of 1.5.

<p>NOTE. Each participant’s change score of pruritus intensity = follow-up VAS score of pruritus intensity – baseline VAS score of pruritus intensity. Similarly, each participant’s change score of a covariate = follow-up data of a covariate – baseline data of a covariate. The appropriate threshold of Kt/V, determined by generalized additive models and receiver operating characteristic analysis, was 1.5. Accordingly, the participants were classified into two categories: those with Kt/V <1.5 and those with Kt/V ≥1.5.</p><p>Abbreviations: AST = Aspartate transaminase; VAS = Visual analog scale.</p>*<p>Ca×P = Product of albumin-adjusted serum calcium (Ca) and serum phosphorus (P).</p>1<p>Model adjusted for covariates of baseline data only (gender, Kt/V, use of high-flux dialyzer, pruritus intensity, creatinine, uric acid, fasting glucose, phosphorus), <i>R</i>² = 0.725.</p>2<p>Model adjusted for the important covariates at baseline (Kt/V, pruritus intensity, AST, and Ca×P) and the change scores of the covariates (uric acid, fasting glucose, and AST), <i>R</i>² = 0.754.</p