Angiotensin-converting enzyme inhibitor usage and acute kidney injury: A secondary analysis of RENAL study outcomes

Aim Acute kidney injury (AKI) is associated with increased mortality. While angiotensin‐converting enzyme inhibitors (ACEI) are known to slow progression of chronic kidney disease, their role in AKI remains unclear. Methods The Randomised Evaluation of Normal vs. Augmented Level Replacement Therapy (RENAL) study data were analysed according to ACEI use over time. The primary outcome was all‐cause mortality at 90 days following randomisation. Analyses used a multivariate Cox model adjusted for either baseline or for time‐dependent covariates, and a sensitivity analysis of patients surviving to at least the median time to ACEI initiation. Results Of the 1463 participants with available data on ACE inhibitors usage, 142 (9.7%) received ACEI at least once during study data collection. Participants treated with ACEI were older (P = 0.02) and had less sepsis at baseline (P