SummaryBackgroundWithholding or continuing angiotensin‐converting enzyme inhibitors or angiotensin 2 receptor blockers peri‐operatively in non‐cardiac surgery remains controversial as they may result in intra‐operative hypotension and postoperative organ damage.MethodsWe included patients prescribed angiotensin‐converting enzyme inhibitors or angiotensin 2 receptor blockers who underwent surgical procedures > 1 h duration under general or spinal anaesthesia from January 2012 to June 2022 in a single centre. We categorised patients by whether these drugs were withheld for 24 h before surgery. We evaluated the association of withholding these drugs before non‐cardiac surgery with creatinine concentrations that increased ≥ 26.4 μmol.l‐1 in the first 48 postoperative hours (acute kidney injury). We also analysed changes in creatinine concentrations and estimated glomerular filtration rates.ResultsAngiotensin‐converting enzyme inhibitors or angiotensin 2 receptor blockers were withheld in 24,285 of 32,933 (74%) patients and continued in 8648 (26%) patients. We used propensity scores for drug discontinuation to match 8631 patient pairs who did or did not continue these drugs: acute kidney injury was recorded for 1791 (21%) patients who continued these drugs vs. 1587 (18%) who did not (OR (95%CI) 1.16 (1.08–1.25), p < 0.001). Intra‐operative hypotension was recorded for 3892 (45%) patients who continued drugs vs. 3373 (39%) patients who did not (OR (95%CI) 1.28 (1.21–1.36), p < 0.001). Continuing drugs was independently associated with a mean increase in creatinine of 2.2 μmol.l‐1 (p < 0.001) and a mean decrease in estimated glomerular filtration rate of 1.4 ml.min.1.73 m‐2 (p < 0.001).ConclusionsContinuing angiotensin‐converting enzyme inhibitors or angiotensin 2 receptor blockers 24 h before non‐cardiac surgery was associated with intra‐operative hypotension and postoperative acute kidney injury.

中文翻译：

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停用或继续使用血管紧张素转换酶抑制剂或血管紧张素2受体阻滞剂与非心脏手术后急性肾损伤的相关性

摘要背景在非心脏手术围手术期停止或继续使用血管紧张素转换酶抑制剂或血管紧张素 2 受体阻滞剂仍然存在争议，因为它们可能导致术中低血压和术后器官损伤。方法我们纳入了服用血管紧张素转换酶抑制剂或血管紧张素 2 受体的患者2012 年 1 月至 2022 年 6 月期间在单一中心在全身麻醉或脊髓麻醉下接受了持续时间 > 1 小时的外科手术的阻滞剂。我们根据手术前 24 小时是否停用这些药物对患者进行分类。我们评估了非心脏手术前停用这些药物与肌酐浓度升高 ≥ 26.4 μmol.l 之间的关系‐1术后 48 小时内（急性肾损伤）。我们还分析了肌酐浓度和估计肾小球滤过率的变化。结果 32,933 名患者中，有 24,285 名 (74%) 患者停用血管紧张素转换酶抑制剂或血管紧张素 2 受体阻滞剂，而 8648 名患者 (26%) 继续使用血管紧张素转换酶抑制剂或血管紧张素 2 受体阻滞剂。我们使用停药倾向评分来匹配 8631 对继续使用或未继续使用这些药物的患者：继续使用这些药物的患者有 1791 名（21%）记录了急性肾损伤，而没有继续使用这些药物的患者有 1587 名（18%）记录了急性肾损伤（或95% CI) 1.16 (1.08–1.25), p < 0.001)。继续用药的患者有 3892 名 (45%)，未继续用药的患者有 3373 名 (39%) 记录有术中低血压（OR (95%CI) 1.28 (1.21–1.36)，p < 0.001）。继续用药与肌酐平均增加 2.2 μmol.l 独立相关‐1(p < 0.001)，估计肾小球滤过率平均下降 1.4 ml.min.1.73 m‐2(p < 0.001)。结论非心脏手术前 24 小时持续使用血管紧张素转换酶抑制剂或血管紧张素 2 受体阻滞剂与术中低血压和术后急性肾损伤相关。