{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T00:29:06Z","timestamp":1791851346208,"version":"4.3.4"},"reference-count":50,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,7,20]],"date-time":"2021-07-20T00:00:00Z","timestamp":1626739200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pharmacol."],"abstract":"<jats:p>\n                    <jats:bold>Background:<\/jats:bold>\n                    Acute kidney injury (AKI) may increase the risk of chronic kidney disease (CKD), development of end-stage renal disease (ESRD), and mortality. However, the impact of exposure to angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker (ACEi\/ARB) in patients experiencing AKI\/acute kidney disease (AKD) is still unclear.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Methods:<\/jats:bold>\n                    In this systematic review, we searched all relevant studies from PubMed, Embase, Cochrane, Medline, Collaboration Central Register of Controlled Clinical Trials, Cochrane Systematic Reviews, and\n                    <jats:ext-link>ClinicalTrials.gov<\/jats:ext-link>\n                    until July 21, 2020. We evaluated whether the exposure to ACEi\/ARB after AKI onset alters recovery paths of AKD and impacts risks of all-cause mortality, recurrent AKI, or incident CKD. We rated the certainty of evidence according to Cochrane methods and the GRADE approach.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Results:<\/jats:bold>\n                    A total of seven articles, involving 70,801 patients, were included in this meta-analysis. The overall patient mortality rate in this meta-analysis was 28.4%. Among AKI patients, all-cause mortality was lower in ACEi\/ARB users than in ACEi\/ARB nonusers (log odds ratio (OR) \u22120.37, 95% confidence interval (CI): \u22120.42\u2013\u22120.32, p &amp;lt; 0.01). The risk of recurrent adverse kidney events after AKI was lower in ACEi\/ARB users than in nonusers (logOR \u22120.25, 95% CI: \u22120.33\u2013\u22120.18, p &amp;lt; 0.01). The risk of hyperkalemia was higher in ACEi\/ARB users than in nonusers (logOR 0.43, 95% CI: 0.27\u20130.59, p &amp;lt; 0.01). Patients with continued use of ACEi\/ARB after AKI also had lower mortality risk than those prior ACEi\/ARB users but who did not resume ACEi\/ARB during AKD (logOR \u22120.36, 95% CI: \u22120.4\u2013\u22120.31, p &amp;lt; 0.01).\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Conclusions:<\/jats:bold>\n                    Exposure to ACEi\/ARB after AKI is associated with lower risks of all-cause mortality, recurrent AKI, and progression to incident CKD. Patients with AKI may have a survival benefit by continued use of ACEi\/ARB; however, a higher incidence of hyperkalemia associated with ACEi\/ARB usage among these patients deserves close clinical monitoring.\n                  <\/jats:p>","DOI":"10.3389\/fphar.2021.665250","type":"journal-article","created":{"date-parts":[[2021,7,20]],"date-time":"2021-07-20T06:08:13Z","timestamp":1626761293000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":35,"title":["The Impact of Angiotensin-Converting Enzyme Inhibitors or Angiotensin II Receptor Blockers on Clinical Outcomes of Acute Kidney Disease Patients: A Systematic Review and Meta-Analysis"],"prefix":"10.3389","volume":"12","author":[{"given":"Jui-Yi","family":"Chen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I-Jung","family":"Tsai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heng-Chih","family":"Pan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hung-Wei","family":"Liao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javier A.","family":"Neyra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vin-Cent","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeff S.","family":"Chueh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,7,20]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"2307","DOI":"10.1097\/hjh.0000000000002187","article-title":"Effects of Mineralocorticoid Receptor Antagonists in Proteinuric Kidney Disease","volume":"37","author":"Alexandrou","year":"2019","journal-title":"J. Hypertens."},{"key":"B2","doi-asserted-by":"publisher","first-page":"1690","DOI":"10.1001\/jamainternmed.2018.4757","article-title":"Use of Renin Angiotensin System Blockers after Acute Kidney Injury","volume":"178","author":"Alpern","year":"2018","journal-title":"JAMA Intern. Med."},{"key":"B3","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1056\/nejm199501123320203","article-title":"The Effect of the Angiotensin-Converting-Enzyme Inhibitor Zofenopril on Mortality and Morbidity after Anterior Myocardial Infarction","volume":"332","author":"Ambrosioni","year":"1995","journal-title":"N. Engl. J. Med."},{"key":"B4","doi-asserted-by":"publisher","first-page":"2219","DOI":"10.1056\/NEJMoa2025845","article-title":"Effect of Finerenone on Chronic Kidney Disease Outcomes in Type 2 Diabetes","volume":"383","author":"Bakris","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"B5","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1186\/s12916-020-01659-x","article-title":"Stopping Renin-Angiotensin System Blockers after Acute Kidney Injury and Risk of Adverse Outcomes: Parallel Population-Based Cohort Studies in English and Swedish Routine Care","volume":"18","author":"Bidulka","year":"2020","journal-title":"BMC Med."},{"key":"B6","doi-asserted-by":"publisher","first-page":"1681","DOI":"10.1001\/jamainternmed.2018.4749","article-title":"Association of Angiotensin-Converting Enzyme Inhibitor or Angiotensin Receptor Blocker Use with Outcomes after Acute Kidney Injury","volume":"178","author":"Brar","year":"2018","journal-title":"JAMA Intern. Med."},{"key":"B7","doi-asserted-by":"publisher","first-page":"448","DOI":"10.2215\/cjn.02440213","article-title":"Association between AKI and Long-Term Renal and Cardiovascular Outcomes in United States Veterans","volume":"9","author":"Chawla","year":"2014","journal-title":"Cjasn"},{"key":"B8","doi-asserted-by":"publisher","first-page":"34265","DOI":"10.1038\/srep34265","article-title":"Losartan Reduces Ensuing Chronic Kidney Disease and Mortality after Acute Kidney Injury","volume":"6","author":"Cheng","year":"2016","journal-title":"Sci. Rep."},{"key":"B9","doi-asserted-by":"publisher","first-page":"263","DOI":"10.1159\/000505896","article-title":"Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers after Acute Kidney Injury: Friend, Foe, or Acquaintance?","volume":"51","author":"Coca","year":"2020","journal-title":"Am. J. Nephrol."},{"key":"B10","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1186\/s12882-016-0337-0","article-title":"Effect of Mineralocorticoid Receptor Antagonists on Proteinuria and Progression of Chronic Kidney Disease: a Systematic Review and Meta-Analysis","volume":"17","author":"Currie","year":"2016","journal-title":"BMC Nephrol."},{"key":"B11","doi-asserted-by":"publisher","first-page":"273","DOI":"10.1159\/000476077","article-title":"A Role of Remote Organs Effect in Acute Kidney Injury Outcome","volume":"137","author":"D\u00e9pret","year":"2017","journal-title":"Nephron"},{"key":"B12","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1159\/000499940","article-title":"Is the Renin-Angiotensin-Aldosterone System Good for the Kidney in Acute Settings?","volume":"143","author":"Dudoignon","year":"2019","journal-title":"Nephron"},{"key":"B13","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1016\/j.amjcard.2015.03.052","article-title":"Meta-Analysis of Large-Scale Randomized Trials to Determine the Effectiveness of Inhibition of the Renin-Angiotensin Aldosterone System in Heart Failure","volume":"116","author":"Emdin","year":"2015","journal-title":"Am. J. Cardiol."},{"key":"B14","doi-asserted-by":"publisher","first-page":"f4930","DOI":"10.1136\/bmj.f4930","article-title":"Acute Kidney Injury: Summary of NICE Guidance","volume":"347","author":"Ftouh","year":"2013","journal-title":"Bmj"},{"key":"B15","doi-asserted-by":"publisher","first-page":"598","DOI":"10.1007\/s00134-018-5160-6","article-title":"Impact of Angiotensin-Converting Enzyme Inhibitors or Receptor Blockers on post-ICU Discharge Outcome in Patients with Acute Kidney Injury","volume":"44","author":"Gayat","year":"2018","journal-title":"Intensive Care Med."},{"key":"B16","doi-asserted-by":"publisher","first-page":"833","DOI":"10.2215\/cjn.12591117","article-title":"Acute Kidney Injury and Risk of Heart Failure and Atherosclerotic Events","volume":"13","author":"Go","year":"2018","journal-title":"Cjasn"},{"key":"B17","doi-asserted-by":"publisher","first-page":"40","DOI":"10.3317\/jraas.2002.007","article-title":"Acute and Long-Term Effects of ACE Inhibition on Renal Haemodynamics in Glomerular and Interstitial Nephropathies","volume":"3","author":"Guidi","year":"2002","journal-title":"J. Renin Angiotensin Aldosterone Syst."},{"key":"B18","first-page":"521","article-title":"Captopril for Prevention of Contrast-Induced Nephropathy in Diabetic Patients: a Randomised Study","volume":"51","author":"Gupta","year":"1999","journal-title":"Indian Heart J."},{"key":"B19","doi-asserted-by":"publisher","first-page":"1294","DOI":"10.1016\/j.jclinepi.2011.03.017","article-title":"GRADE Guidelines: 7. Rating the Quality of Evidence-Inconsistency","volume":"64","author":"Guyatt","year":"2011","journal-title":"J. Clin. Epidemiol."},{"key":"B20","doi-asserted-by":"publisher","first-page":"742","DOI":"10.1053\/j.ajkd.2015.10.019","article-title":"Acute Kidney Injury Recovery Pattern and Subsequent Risk of CKD: An Analysis of Veterans Health Administration Data","volume":"67","author":"Heung","year":"2016","journal-title":"Am. J. Kidney Dis."},{"key":"B21","doi-asserted-by":"publisher","first-page":"d5928","DOI":"10.1136\/bmj.d5928","article-title":"The Cochrane Collaboration's Tool for Assessing Risk of Bias in Randomised Trials","volume":"343","author":"Higgins","year":"2011","journal-title":"Bmj"},{"key":"B22","doi-asserted-by":"publisher","first-page":"266","DOI":"10.1159\/000505893","article-title":"Use of Angiotensin-Converting Enzyme Inhibitors\/Angiotensin Receptor Blockers and Acute Kidney Disease after an Episode of AKI: A Multicenter Prospective Cohort Study","volume":"51","author":"Hines","year":"2020","journal-title":"Am. J. Nephrol."},{"key":"B23","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1056\/NEJMoa053107","article-title":"Efficacy and Safety of Benazepril for Advanced Chronic Renal Insufficiency","volume":"354","author":"Hou","year":"2006","journal-title":"N. Engl. J. Med."},{"key":"B24","doi-asserted-by":"publisher","first-page":"914","DOI":"10.1681\/asn.2014111114","article-title":"Elevated BP after AKI","volume":"27","author":"Hsu","year":"2016","journal-title":"Jasn"},{"key":"B25","doi-asserted-by":"publisher","first-page":"26","DOI":"10.2215\/cjn.05800519","article-title":"Renin-Angiotensin System Blockade after Acute Kidney Injury (AKI) and Risk of Recurrent AKI","volume":"15","author":"Hsu","year":"2020","journal-title":"Cjasn"},{"key":"B26","doi-asserted-by":"publisher","first-page":"h870","DOI":"10.1136\/bmj.h870","article-title":"Use of GRADE for Assessment of Evidence about Prognosis: Rating Confidence in Estimates of Event Rates in Broad Categories of Patients","volume":"350","author":"Iorio","year":"2015","journal-title":"Bmj"},{"key":"B27","doi-asserted-by":"publisher","first-page":"c179","DOI":"10.1159\/000339789","article-title":"KDIGO Clinical Practice Guidelines for Acute Kidney Injury","volume":"120","author":"Khwaja","year":"2012","journal-title":"Nephron"},{"key":"B28","doi-asserted-by":"publisher","first-page":"e8525","DOI":"10.1136\/bmj.e8525","article-title":"Concurrent Use of Diuretics, Angiotensin Converting Enzyme Inhibitors, and Angiotensin Receptor Blockers with Non-steroidal Anti-inflammatory Drugs and Risk of Acute Kidney Injury: Nested Case-Control Study","volume":"346","author":"Lapi","year":"2013","journal-title":"Bmj"},{"key":"B29","doi-asserted-by":"publisher","first-page":"273","DOI":"10.1111\/j.1755-5922.2011.00299.x","article-title":"Is Angiotensin-Converting Enzyme Inhibitor a Contraindication for Contrast-Induced Nephropathy Prophylaxis? A Review about its Paradox","volume":"30","author":"Li","year":"2012","journal-title":"Cardiovasc. Ther."},{"key":"B30","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1097\/hjh.0000000000001876","article-title":"Potential Target-Organ protection of Mineralocorticoid Receptor Antagonist in Acute Kidney Disease","volume":"37","author":"Lin","year":"2019","journal-title":"J. Hypertens."},{"key":"B31","doi-asserted-by":"publisher","first-page":"1592","DOI":"10.1093\/ndt\/16.8.1592","article-title":"Haemodynamic Effects of Valsartan in Acute Renal Ischaemia\/reperfusion Injury","volume":"16","author":"Lopau","year":"2001","journal-title":"Nephrol. Dial. Transpl."},{"key":"B32","doi-asserted-by":"publisher","first-page":"2","DOI":"10.2215\/cjn.13801119","article-title":"Renin-Angiotensin System Blockade after Acute Kidney Injury","volume":"15","author":"Menez","year":"2020","journal-title":"Cjasn"},{"key":"B33","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1254\/jphs.fmj05003x2","article-title":"Molecular Mechanisms and Therapeutic Strategies of Chronic Renal Injury: Physiological Role of Angiotensin II-Induced Oxidative Stress in Renal Medulla","volume":"100","author":"Mori","year":"2006","journal-title":"J. Pharmacol. Sci."},{"key":"B34","doi-asserted-by":"publisher","first-page":"p39","DOI":"10.1159\/000071289","article-title":"Angiotensin II Blockade Augments Renal Cortical Microvascular pO2 Indicating a Novel, Potentially Renoprotective Action","volume":"94","author":"Norman","year":"2003","journal-title":"Nephron Physiol."},{"key":"B35","doi-asserted-by":"publisher","first-page":"847","DOI":"10.1007\/s40620-016-0321-6","article-title":"Dialysis Requirement, Long-Term Major Adverse Cardiovascular Events (MACE) and All-Cause Mortality in Hospital Acquired Acute Kidney Injury (AKI): a Propensity-Matched Cohort Study","volume":"29","author":"Omotoso","year":"2016","journal-title":"J. Nephrol."},{"key":"B36","doi-asserted-by":"publisher","first-page":"294","DOI":"10.1016\/j.kint.2020.04.020","article-title":"Controversies in Acute Kidney Injury: Conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Conference","volume":"98","author":"Ostermann","year":"2020","journal-title":"Kidney Int."},{"key":"B37","doi-asserted-by":"publisher","first-page":"987","DOI":"10.1097\/sla.0000000000001582","article-title":"Acute and Chronic Kidney Disease and Cardiovascular Mortality after Major Surgery","volume":"264","author":"Ozrazgat-Baslanti","year":"2016","journal-title":"Ann. Surg."},{"key":"B38","doi-asserted-by":"publisher","first-page":"1066","DOI":"10.1016\/j.kint.2019.07.003","article-title":"\"Permissive AKI\" with Treatment of Heart Failure","volume":"96","author":"Parikh","year":"2019","journal-title":"Kidney Int."},{"key":"B39","doi-asserted-by":"publisher","first-page":"186","DOI":"10.1053\/j.ackd.2016.01.014","article-title":"Delayed Consequences of Acute Kidney Injury","volume":"23","author":"Parr","year":"2016","journal-title":"Adv. Chronic Kidney Dis."},{"key":"B40","doi-asserted-by":"publisher","first-page":"718","DOI":"10.1001\/jamainternmed.2020.0193","article-title":"Association between Renin-Angiotensin System Blockade Discontinuation and All-Cause Mortality Among Persons with Low Estimated Glomerular Filtration Rate","volume":"180","author":"Qiao","year":"2020","journal-title":"JAMA Intern. Med."},{"key":"B41","doi-asserted-by":"publisher","first-page":"257","DOI":"10.1097\/HJH.0b013e3282f09f79","article-title":"Renovascular Hypertension by Two-Kidney One-Clip Enhances Endothelial Progenitor Cell Mobilization in a P47phox-dependent Manner","volume":"26","author":"Salguero","year":"2008","journal-title":"J. Hypertens."},{"key":"B42","doi-asserted-by":"publisher","first-page":"148","DOI":"10.1186\/s13054-019-2447-0","article-title":"Renin-angiotensin-aldosterone System Blockers after KDIGO Stage 3 Acute Kidney Injury: Use and Impact on 2-year Mortality in the AKIKI Trial","volume":"23","author":"Scarton","year":"2019","journal-title":"Crit. Care"},{"key":"B43","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1016\/j.amjmed.2016.09.016","article-title":"30-Day Readmissions after an Acute Kidney Injury Hospitalization","volume":"130","author":"Silver","year":"2017","journal-title":"Am. J. Med."},{"key":"B44","doi-asserted-by":"publisher","first-page":"154","DOI":"10.1016\/j.phrs.2016.03.018","article-title":"ACE Inhibition, ACE2 and Angiotensin-(1-7) axis in Kidney and Cardiac Inflammation and Fibrosis","volume":"107","author":"Sim\u00f5es","year":"2016","journal-title":"Pharmacol. Res."},{"key":"B45","doi-asserted-by":"publisher","first-page":"768","DOI":"10.1159\/000489913","article-title":"Effects of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers on All-Cause Mortality and Renal Outcomes in Patients with Diabetes and Albuminuria: a Systematic Review and Meta-Analysis","volume":"43","author":"Wang","year":"2018","journal-title":"Kidney Blood Press. Res."},{"key":"B46","doi-asserted-by":"publisher","first-page":"e13","DOI":"10.1161\/hyp.0000000000000065","article-title":"2017 ACC\/AHA\/AAPA\/ABC\/ACPM\/AGS\/APhA\/ASH\/ASPC\/NMA\/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines","volume":"71","author":"Whelton","year":"2018","journal-title":"Hypertension"},{"key":"B47","doi-asserted-by":"publisher","first-page":"e012674","DOI":"10.1136\/bmjopen-2016-012674","article-title":"What Are the Risks and Benefits of Temporarily Discontinuing Medications to Prevent Acute Kidney Injury? A Systematic Review and Meta-Analysis","volume":"7","author":"Whiting","year":"2017","journal-title":"BMJ Open"},{"key":"B48","doi-asserted-by":"publisher","first-page":"1225","DOI":"10.1016\/j.jval.2020.01.024","article-title":"Nephrologist Follow-Up Care of Patients with Acute Kidney Disease Improves Outcomes: Taiwan Experience","volume":"23","author":"Wu","year":"2020","journal-title":"Value in Health"},{"key":"B49","doi-asserted-by":"publisher","first-page":"595","DOI":"10.1681\/asn.2013060610","article-title":"Long-term Risk of Coronary Events after AKI","volume":"25","author":"Wu","year":"2014","journal-title":"Jasn"},{"key":"B50","doi-asserted-by":"publisher","first-page":"717","DOI":"10.1161\/circulationaha.110.955369","article-title":"Angiotensin-converting Enzyme 2 Suppresses Pathological Hypertrophy, Myocardial Fibrosis, and Cardiac Dysfunction","volume":"122","author":"Zhong","year":"2010","journal-title":"Circulation"}],"container-title":["Frontiers in Pharmacology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphar.2021.665250\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,7,20]],"date-time":"2021-07-20T06:08:17Z","timestamp":1626761297000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphar.2021.665250\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7,20]]},"references-count":50,"alternative-id":["10.3389\/fphar.2021.665250"],"URL":"https:\/\/doi.org\/10.3389\/fphar.2021.665250","relation":{"has-review":[{"id-type":"doi","id":"10.3410\/f.740606767.793587877","asserted-by":"object"}]},"ISSN":["1663-9812"],"issn-type":[{"value":"1663-9812","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,7,20]]},"article-number":"665250"}}