Brazilian Journal of Anesthesiology (English Edition) · Published 2026-07-01 · DOI 10.1016/j.bjane.2026.844786
Iñigo Rubio, Angel Candela, Gemma Echarri, Raquel Callejas, Eduardo Tamayo, David Nagore, Jorge M. Núñez-Córdoba, Marc Vives
Background: The impact of preoperative Angiotensin-Converting Enzyme Inhibitors or Angiotensin Receptor Blockers (ACEI/ARB) on cardiac surgery-associated Acute Kidney Injury (AKI) remains elusive. We sought to evaluate the association of ACEI/ARB use with stage 2 or 3 AKI and in-hospital mortality, while evaluating whether preoperative withholding versus continuation strategies modulate clinical outcomes. Methods: Multicenter prospective cohort study involving 14 Spanish and British hospitals. The study population comprised high-risk cardiac surgery patients (Cleveland Clinic Score ≥ 4). Results: Among 249 patients (mean age: 69.5 years; 39% women; 53.8% ACEI/ARB users), the overall incidence of stage 2 or 3 AKI was 32.9%. ACEI/ARB use was associated with a significantly higher likelihood of stage 2 to 3 AKI (38.8% vs. 26.1%; adjusted OR = 2.79; 95% CI 1.47–5.30; p = 0.002). The adjusted risk difference was 0.188 (95% CI 0.079–0.298; p = 0.001), yielding a number needed to harm of 5.3. Sensitivity analyses confirmed the robustness of these findings, with an E-value of 2.73 (lower limit: 1.72) and consistent results using augmented inverse probability weighting (average treatment effect: 0.191; 95% CI 0.081–0.300; p = 0.001). No statistically significant associations were observed in in-hospital mortality or the impact of preoperative withholding versus continuation strategies on clinical outcomes. Conclusion: This study suggests preoperative ACEI/ARB use may be associated with an increased incidence of stage 2 or 3 AKI. While differences in in-hospital mortality and preoperative withholding versus continuation strategies did not reach statistical significance, these findings reveal clinical trends that warrant further investigation.
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Rubio, I., Candela, A., Echarri, G., et al. (2026). Preoperative angiotensin-converting enzyme inhibitor or angiotensin receptor blocker use and acute kidney injury after high-risk cardiac surgery: a multicenter prospective cohort study. Brazilian Journal of Anesthesiology (English Edition). https://doi.org/10.1016/j.bjane.2026.844786