Effects of Renin-Angiotensin-Aldosterone System Inhibitor Discontinuation After Acute Kidney Injury on Mortality: A Retrospective Analysis.

Guideline directed medical therapy to include renin-angiotensin-aldosterone inhibitors (RAASi) has led to a significant reduction in heart failure mortality. These medications, however, are often discontinued on admission for an acute kidney injury and never restarted. The impact of this discontinuation on mortality is unknown. This retrospective, propensity matched, analysis between 2016 and 2021 sought to examine the impact that discontinuation of RAASi, after an acute kidney injury, has on 1 year mortality in patients with heart failure. Data were obtained using the electronic health record of a tertiary care health system in the United States. The exposure was whether the patient's RAASi was discontinued on discharge and the outcome was 1 year mortality. We found that, among patients admitted for an acute kidney injury with heart failure who were on an RAASi at the time of admission (n = 512), discontinuation of the patient's RAASi on discharge was associated with 1.96 times as many deaths at 1 year (OR 1.96, 95% CI 1.28 to 2.99, p <0.001) compared to those who were continued on their RAASi. These findings emphasize the potential impact on patient outcomes and the importance of optimizing treatment regimens in this high-risk population.