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To determine whether preoperative RAS inhibitors use within 7 days of surgery is associated with lower incidence of postoperative AKI in hypertensive patients.
We retrospectively collected 12,545 hypertensive patients undergoing surgery in the Third Xiangya Hospital of Central South University from February 2007 to November 2015. According to the use of RASI within 7 days before surgery, patients were divided into RASI group and non RASI group. We used propensity matching with a greedy 1-to-1digit-matching algorithm and logistic regression to examine the association between preoperative RASI use and postoperative AKI. In addition, according to the exposure to different kind of antihypertensive drugs, patients were further grouped into RASI group, CCB group, diuretics group and control group. Chi square test was used to compare the difference of AKI incidence among different groups.
Among the 12,545 hypertensive patients undergoing surgery who met the inclusion criteria, 18.74% received preoperative RASI within 7 days of surgery. After propensity matching, 2192 patients in each group were matched successfully. The incidence of postoperative AKI in RASI group is significantly lower than that in non RASI group, respectively 7.39% and 12.32% (P < 0.001). Conditional logistic regression analysis showed that infection (OR:1.93; 95%CI:1.56-2.38), kidney disease (OR:1.39; 95%CI:1.12-1.73), diuretics (OR:1.46; 95%CI:1.08-1.95) increase the risk of AKI after surgery. In addition, compared with control group, preoperative RASI can reduce the incidence of postoperative AKI (OR:0.55; 95%CI:0.33-0.90), preoperative CCB had no effect on postoperative AKI (OR:0.86; 95%CI:0.71-1.03), but the preoperative diuretics increased the incidence of postoperative AKI (OR:3.28; 95%CI:2.65-4.06).
Preoperative use of RASI in hypertensive patients can reduce the incidence of postoperative AKI. The risk factors of AKI in patients with hypertension include infection, kidney disease, diuretics.