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The use of anti-adrenergic agents as a predictor of acute kidney injury and delayed recovery of kidney function: the NARA-AKI cohort study

Hypertension Research volume 46, pages 2470–2477 (2023)Cite this article

Abstract

Association of preoperative regular use of anti-adrenergic agents with postoperative acute kidney injury (AKI) and with trajectory of kidney function after AKI is still unknown. In a retrospective cohort study, adults undergoing non-cardiac surgery under general anesthesia were included. Obstetric or urological surgery, missing data, or preoperative dialysis was excluded. The exposure of interest was preoperative regular use of anti-adrenergic agents. The outcomes were AKI within 1 week postoperatively and trajectories of kidney function within 2 weeks postoperatively among patients with AKI. Multivariable logistic regression models were used to examine the association of anti-adrenergic agents with AKI. Linear mixed-effects models were used to compare the trajectories of postoperative kidney function after AKI between patients with and without anti-adrenergic agents. Among 5168 patients, 245 had used anti-adrenergic agents. A total of 309 (6.0%) developed AKI, and the use of anti-adrenergic agents was independently associated with postoperative AKI even after adjustment for preoperative and intraoperative potential confounders [odds ratio (95% confidence interval): 1.76 (1.14–2.71)]. The association was similar across preexisting hypertension or cardiovascular disease. Analyses restricted to patients with AKI suggested that the timing and stage of AKI were similar among those with and without anti-adrenergic agents; however, the recovery of kidney function was delayed among those with anti-adrenergic agents (P for interaction = 0.004). The use of anti-adrenergic agents was associated with postoperative AKI and delayed recovery of kidney function after AKI. Temporary withdrawal of anti-adrenergic agents during perioperative periods may contribute to prevent AKI and shorten the duration of AKI.

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Data availability

The study data are available from the corresponding author on reasonable request.

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Funding

This study was supported by the Nara Medical University Grant-in-Aid for Young Scientists.

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Authors and Affiliations

  1. Department of Nephrology, Nara Medical University, Kashihara, Japan

    Masatoshi Nishimoto, Miho Murashima, Masaru Matsui, Masahiro Eriguchi, Ken-ichi Samejima, Yasuhiro Akai & Kazuhiko Tsuruya

  2. Department of Nephrology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan

    Miho Murashima

  3. Department of Nephrology, Nara Prefecture General Medical Center, Nara, Japan

    Maiko Kokubu & Masaru Matsui

Authors
  1. Masatoshi Nishimoto
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  2. Miho Murashima
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  3. Maiko Kokubu
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  5. Masahiro Eriguchi
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  6. Ken-ichi Samejima
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  7. Yasuhiro Akai
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Contributions

Conception or design, analysis, and interpretation of data: MN, MMu, MK, and KT. Drafting or revision of the article: MN, MMu, MK, MMa, ME, KS, YA, and KT. Provision of important intellectual content: MMu, MMa, ME, KS, YA, and KT. Final approval of the version to be published: MN, MMu, MK, MMa, ME, KS, YA, and KT.

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Correspondence to Miho Murashima.

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Nishimoto, M., Murashima, M., Kokubu, M. et al. The use of anti-adrenergic agents as a predictor of acute kidney injury and delayed recovery of kidney function: the NARA-AKI cohort study. Hypertens Res 46, 2470–2477 (2023). https://doi.org/10.1038/s41440-023-01352-5

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