{"id":23962,"date":"2025-08-26T16:47:00","date_gmt":"2025-08-26T20:47:00","guid":{"rendered":"https:\/\/www.ices.on.ca\/?post_type=journal_article&#038;p=23962"},"modified":"2026-05-11T16:53:59","modified_gmt":"2026-05-11T20:53:59","slug":"prior-use-of-renin-angiotensin-system-inhibitors-and-risk-of-renal-replacement-therapy-in-critically-ill-elderly-patients-with-sepsis-a-population-based-cohort-study","status":"publish","type":"journal_article","link":"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/prior-use-of-renin-angiotensin-system-inhibitors-and-risk-of-renal-replacement-therapy-in-critically-ill-elderly-patients-with-sepsis-a-population-based-cohort-study\/","title":{"rendered":"Prior use of renin-angiotensin system inhibitors and risk of renal replacement therapy in critically ill elderly patients with sepsis: a population-based cohort study"},"content":{"rendered":"<p><strong>Objectives<\/strong> \u2014 We sought to estimate the association between chronic use of renin-angiotensin system inhibitors and acute kidney injury requiring renal replacement therapy in critically ill adult patients with sepsis.<\/p>\n<p><strong>Design<\/strong> \u2014 Population-based cohort study in Ontario, Canada.<\/p>\n<p><strong>Setting<\/strong> \u2014 ICUs in Ontario, Canada, between April 2008 and March 2019.<\/p>\n<p><strong>Patients<\/strong> \u2014 Elderly patients admitted to an ICU with a sepsis diagnosis; we excluded patients with established indications of renin-angiotensin system inhibitors.<\/p>\n<p><strong>Interventions<\/strong> \u2014 The prior use (i.e., within 100 d of hospitalization) of an angiotensin-converting enzyme inhibitor or an angiotensin II receptor blocker served as the main exposure of interest; the active comparator was the prior use of calcium channel blockers.<\/p>\n<p><strong>Measurements and main results<\/strong> \u2014 Acute kidney injury requiring renal replacement therapy was the primary outcome. Septic shock and all-cause mortality at 30 days served as secondary outcomes. We fitted multivariable modified Poisson regression models to adjust for potential confounders; associations were reported as risk ratios (RRs) alongside 95% CIs. We included 8621 patients, of whom 81% received a renin-angiotensin system inhibitor; mean age was 78 years. Renal replacement therapy was performed in 3.2% of patients; compared with the prior use of a calcium channel blocker, prior use of a renin-angiotensin system inhibitor was associated with a higher risk of acute kidney injury and renal replacement therapy (RR, 1.57; 95% CI, 1.10\u20132.24), septic shock (RR, 1.18; 95% CI, 1.04\u20131.33), but not all-cause mortality at 30 days (RR, 0.93; 95% CI, 0.88\u20131.01). Our results were robust across sensitivity analyses.<\/p>\n<p><strong>Conclusions<\/strong> \u2014 Chronic use of a renin-angiotensin system inhibitor is associated with a higher risk of renal replacement therapy and septic shock in adult patients with sepsis.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Objectives \u2014 We sought to estimate the association between chronic use of renin-angiotensin system inhibitors and acute kidney injury requiring renal replacement therapy in critically ill adult patients with sepsis. Design \u2014 Population-based cohort study in Ontario, Canada. Setting \u2014 ICUs in Ontario, Canada, between April 2008 and March 2019. Patients \u2014 Elderly patients admitted [&hellip;]<\/p>\n","protected":false},"template":"","migration-helper-automated":[],"migration-manual":[],"topic":[49,17,56],"migration-helper-qa-sample-set":[],"class_list":["post-23962","journal_article","type-journal_article","status-publish","hentry","topic-kidney-disease","topic-older-people","topic-pharmacoepidemiology-and-drug-safety"],"acf":{"citation":"Otero Castro V, Scales DC, Angriman F. <em>Crit Care Explor<\/em>. 2025; 7(9):e1304.","source_url":"https:\/\/doi.org\/10.1097\/cce.0000000000001304","ices_scientist":[1364],"site":[6733],"research_program":[6747],"news_release":"","journal_article":"","atlas":"","research_report":"","infographic":"","video":"","downloads":null,"links":null,"sitecore_item_id":"","sitecore_item_name":"","sitecore_field_values":"","previous_url":""},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>ICES | Prior use of 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