Dr Candice Khor1, Dr Maria Maawad1, Dr Jonathan Erlich1, Prof Zoltan Endre1
1Prince of Wales Hospital, Randwick, Australia
Aim:
To describe clinical practice around medication cessation and recommencement in acute kidney injury (AKI)
Background:
Angiotensin converting enzyme inhibitors (ACE-i), angiotensin receptor blockers (ARB), metformin and sodium-glucose cotransporter-2 inhibitors (SGLT2-i) are commonly withheld in AKI despite limited evidence supporting this clinical practice. The proportion of patients not recommenced on these medications that have protective effects is unknown.
Methods:
An audit was undertaken on inpatients consulted for AKI in 2021 at Prince of Wales Hospital (POWH). Demographic, laboratory and clinical data were retrieved from electronic medical records.
Results:
Out of approximately 1020 patients with AKI detected yearly by the POWH AKI electronic alert, 104 were consulted by nephrology in 2021. ACE-I and ARB were withheld in all 40 patients and restarted in 9 out of 33 (27%) who survived the admission and in 4 outpatients. No patients recommenced on ACE-I or ARB died suggesting they can be safely used post AKI and likely protective. SGLT2-i was withheld in 6 out of 7 patients and recommenced in 3 patients (43%) on discharge and in 1 outpatient. Metformin was withheld in 19 out of 22 patients and recommenced in 13 out of 20 (65%) who survived the admission and in 3 outpatients. 36 (35%) patients had renal follow-up at POWH, 15 (14%) lived outside the POWH catchment area, 21 (20%) did not attend nephrology follow-up, 21 (20%) had poor prognosis or died in hospital and 11 (11%) had no renal follow-up organised.
Conclusion:
ACE-I, ARB, SGLT2-i and metformin were withheld in most patients and recommenced in 27%, 43% and 65% of patients respectively on discharge, highlighting the importance of AKI follow-up to review timing of medication recommencement.
Biography:
Dr Candice Khor is currently the renal fellow at the Prince of Wales Hospital in Sydney, Australia. She recently completed her renal advanced training. Her clinical and research interests include acute kidney injury, glomerulonephritis and renal transplant.