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Acute Kidney Injury: An Acceptable Risk of Treatment with Renin-Angiotensin System Blockade in Primary Care?

Overview of attention for article published in Canadian Journal of Kidney Health and Disease, April 2015
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Title
Acute Kidney Injury: An Acceptable Risk of Treatment with Renin-Angiotensin System Blockade in Primary Care?
Published in
Canadian Journal of Kidney Health and Disease, April 2015
DOI 10.1186/s40697-015-0044-y
Pubmed ID
Authors

Michael Bedford, Christopher KT Farmer, Jean Irving, Paul E Stevens

Abstract

Use of renin-angiotensin system (RAS) blockade has become increasingly widespread driven by evidence-based guidance. There is concern about the role of these agents in the genesis of avoidable acute kidney injury (AKI). To investigate the association between AKI and use of RAS blockade. Multilevel hierarchical analysis of a large cohort of patients registered with UK general practitioners. Primary care practices in East and West Kent, United Kingdom. 244,715 patients from 27 practices. Demographic, clinical, biochemical and prescription data. Analyses of data acquired between 02/3/2004 and 17/04/2012 using multilevel logistic regression to determine the relationship between AKI and use of RAS blockade; further analysed by indication for treatment with RAS blockade. Sufficient serum creatinine data were available to define AKI in 63,735 patients with 208,275 blood test instances. In 95,569 instances the patient was prescribed a RAS antagonist of which 5.4% fulfilled criteria for AKI. The unadjusted odds ratio (OR) for AKI in those prescribed RAS blockade was 1.93 (1.81-2.06, 95%CI) falling to 1.11 (1.02-1.20, 95%CI) when adjusted for age, gender, co-morbidity, GFR category, proteinuria, systolic blood pressure and diuretic therapy. In patients with an evidence-based indication there was no difference in absolute risk of AKI. However, prescription of RAS blockade in the absence of indication appeared to be associated with greater risk of AKI. When analysis was repeated with AKIN2/AKIN3 as the outcome, although risk of AKI remained significant when unadjusted (OR 1.73, 95%CI 1.42-2.11, p<0.001), after full adjustment there was no increased risk (OR 0.83, 95%CI 0.63-1.09) in those taking RAS antagonists. However, when analysed by indication AKIN2/AKIN3 was significantly more likely in those prescribed RAS antagonists without indication (OR 2.04, 95%CI 1.41-2.94, p<0.001). Observational database study. No information concerning hospitalisation. Prescribing assumptions and potential inaccurate coding. Potential survival bias; patients surviving longer will contribute more data. Use of RAS antagonists increased the risk of AKI, independent of common confounding variables. After correction for confounders the risk fell away and became non-significant for moderate and severe AKI. However, where there was no evidence-based indication for RAS antagonists the risk of AKI, whether mild, moderate or severe, remained greater.

Mendeley readers

The data shown below were compiled from readership statistics for 17 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
United Kingdom 1 6%
Canada 1 6%
Unknown 15 88%

Demographic breakdown

Readers by professional status Count As %
Student > Ph. D. Student 4 24%
Researcher 4 24%
Student > Master 3 18%
Professor 2 12%
Other 2 12%
Other 2 12%
Readers by discipline Count As %
Medicine and Dentistry 9 53%
Nursing and Health Professions 4 24%
Psychology 1 6%
Earth and Planetary Sciences 1 6%
Engineering 1 6%
Other 0 0%
Unknown 1 6%

Attention Score in Context

This research output has an Altmetric Attention Score of 1. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 30 June 2015.
All research outputs
#11,455,347
of 17,654,026 outputs
Outputs from Canadian Journal of Kidney Health and Disease
#307
of 384 outputs
Outputs of similar age
#131,955
of 238,499 outputs
Outputs of similar age from Canadian Journal of Kidney Health and Disease
#1
of 1 outputs
Altmetric has tracked 17,654,026 research outputs across all sources so far. This one is in the 23rd percentile – i.e., 23% of other outputs scored the same or lower than it.
So far Altmetric has tracked 384 research outputs from this source. They typically receive a little more attention than average, with a mean Attention Score of 5.4. This one is in the 12th percentile – i.e., 12% of its peers scored the same or lower than it.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 238,499 tracked outputs that were published within six weeks on either side of this one in any source. This one is in the 35th percentile – i.e., 35% of its contemporaries scored the same or lower than it.
We're also able to compare this research output to 1 others from the same source and published within six weeks on either side of this one. This one has scored higher than all of them