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- Open Access
Prescription of cardioprotective drugs after acute kidney injury
© El-Solia et al.; 2015
- Published: 1 October 2015
- Intensive Care Unit
- Chronic Kidney Disease
- Hospital Discharge
- Renal Replacement Therapy
It is estimated that 5% of critically ill patients with acute kidney injury (AKI) require renal replacement therapy (RRT). Increasing data suggests that they have an increased risk of progressive chronic kidney disease, cardiovascular morbidity and premature death. The exact reasons for these poor outcomes following AKI are incompletely understood. Discontinuation of cardioprotective drugs may be an important factor.
To describe the influence of AKI requiring RRT on long term cardioprotective drug prescription in survivors to hospital discharge during a two year period.
We identified all patients who received RRT for AKI in a large tertiary Intensive Care Unit (ICU) over a two year period. For those who recovered to RRT independence and survived to hospital discharge, documentation at admission and discharge from ICU and the hospital were reviewed to assess changes to medications and the information conveyed to primary care. We focussed on the following drugs: Metformin, renin-angiotensin-system blockers, beta-blockers, K sparing diuretics, statins and antiplatelet agents. Where patients were repatriated to other hospitals letters were sent to the general practitioners.
Patients on cardioprotective drugs pre admission
CKD stage at hospital discharge as per eGFR
Number of patients with severe AKI who survived to hospital discharge
Number of patients
Mean baseline eGFR pre-hospitalisation (when available)
Mean eGFR at hospital discharge
Number of patients in whom cardioprotective drugs were discontinued and not restarted after hospital discharge
Appropriate documentation in hospital discharge letter regarding AKI and drug discontinuation (% of relevant patients)
>60 (2 pts)
38.9 (9 pts)
59.4 (21 pts)
44.1 (7 pts)
I or II
>60 (22 pts)
1. It was common for patients with AKI to be prescribed cardioprotective drugs at the time of admission and for some or all to be discontinued during critical illness. Many patients recovered a good level of renal function by hospital discharge but still had medications discontinued. Whilst it may have been appropriate during the acute illness, prolonged discontinuation may have had an effect on the stability of co-morbid disease in the longer term.
2. Although primary care physicians are increasingly responsible for management of chronic conditions and rely upon accurate and complete information from secondary care, the transfer of relevant information related to medication management was frequently sub-optimal
The work was undertaken during an ERA-EDTA Young Fellowship.
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.