Electronic Thesis and Dissertation Repository

Degree

Master of Science

Program

Epidemiology and Biostatistics

Supervisor

Dr. Amit Garg

Abstract

Angiotensin converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB) use prior to major surgery is controversial. We performed a population based retrospective cohort study of 237,208 elderly patients (of whom 101,494 (42.8%) were ACEi or ARB users) who underwent major elective surgery from 1995 to 2010 in Ontario, Canada. The primary outcome was acute kidney injury treated with dialysis (AKI-D) within 14 days following surgery (810 (0.34%) patients). The secondary outcome was all-cause mortality within 90 days following surgery (11,089 (4.67%) patients). After adjusting for potential confounders, preoperative ACEi or ARB use was associated with a lower relative risk of AKI-D (adjusted relative risk (RR): 0.83; 95% confidence interval (CI): 0.71 to 0.98) and a lower relative risk of all-cause mortality (adjusted RR: 0.91; 95% CI: 0.87 to 0.95). Results were consistent in propensity score matched analyses. We observed a significant effect modification by chronic kidney disease on AKI-D (p-value < 0.0001). Randomized controlled trials are needed to clarify this issue.


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Nephrology Commons

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