Temporarily stopping taking medicine to prevent acute kidney injury when unwell: risks and benefits
Kidney function can decrease suddenly when someone becomes unwell, for example with an infection or diarrhoea and vomiting. The chance of this happening is greater when the person is elderly, has other medical problems or is taking certain medicine.
This drop in kidney function is called acute kidney injury (AKI). An affected person is more likely to be admitted to hospital and people in hospital with acute kidney injury spend longer there than those without AKI. One in four patients admitted to hospital with acute kidney injury do not survive. Those that do are often left with long term kidney damage.
Some experts suggest that advising patients to stop taking certain medicines during illnesses – known as “sick day rules” – could reduce the chances of acute kidney injury. These medicines include water tablets (diuretics), and a type of blood pressure tablets called renin angiotensin aldosterone system (RAAS) inhibitors.
However the risks of not taking these medications have not been fully explored, and the relationship between these medications and AKI in a ’real world’ setting is not clear.
Project aims
Previously, we reviewed six studies about the effect of stopping taking certain medicines on the risk of AKI in adults. These studies found that people who continued to take their medicines prior to coronary angiography tests or heart surgery may have had a small increased risk of kidney injury, compared to those who stopped taking them.
This systematic review showed that more research was needed to look at the effect of stopping taking medicines on kidney function in people who aren’t in hospital, when they are unwell.
This latest study aimed to provide more clarity on the relative risks and benefits of withdrawing medications during periods of illness, by exploring the link between RAAS inhibitors, diuretics and AKI, to inform “sick day rule” advice
What we did
We compared GP records for a group of patients taking RAAS inhibitors or diuretics for long-term conditions (e.g. hypertension, heart failure) to another group of patients taking similar medication for the same long-term conditions. Both groups were matched in age, sex, and the length of time they’d had their chronic condition. We also adjusted for other factors such as blood pressure, smoking status, and kidney function, to more fairly compare AKI rates between the two groups.
What we found and what this means
Our results supported previously published research in finding an increased risk of AKI in patients prescribed RAAS inhibitors and diuretics. However, the results suggested the overall increased risk of AKI was low and likely to be outweighed by the beneficial effects of the medications.
What next?
It would be helpful to know whether patients who have been advised to stop taking their medications temporarily while they are unwell follow this advice in practice and whether or not they come to any harm if they do so. New studies investigating the impact of such “sick day rules” should weigh up any negative effects of stopping medications such as diuretics and RAAS inhibitors, against the potential benefit in terms of avoidance of AKI.
Papers
Estimating the risk of acute kidney injury associated with use of diuretics and renin angiotensin aldosterone system inhibitors: A population based cohort study using the clinical practice research datalink
Read the paper
What are the risks and benefits of temporarily discontinuing medications to prevent acute kidney injury? A systematic review and meta-analysis
Read the paperLead collaborators
- Dr Fergus Caskey, University of Bristol
ARC West Staff
Professor Jeremy Horwood
Professor of Social Sciences and Health
Professor Yoav Ben-Shlomo
Cross-cutting Methodological Theme LeadPartners on this project
Bristol, North Somerset and South Gloucestershire Integrated Care Board
The Integrated Care Board (ICB) is responsible for the day-to-day running of the NHS. The NHS Bristol, North Somerset and South Gloucestershire ICB takes account of population needs, arranges for the provision of services and manages the NHS budget.
North Bristol NHS Trust
North Bristol NHS Trust is one of the largest teaching trusts in the country and serves the population of Bristol, South Gloucestershire and North Somerset. Their internationally renowned specialist areas include neurosciences, renal, orthopaedics, major trauma, urology, plastic surgery and neo-natal intensive care.
University Hospitals Bristol and Weston NHS Foundation Trust
University Hospitals Bristol and Weston NHS Foundation Trust is a dynamic group of hospitals in the heart of Bristol and Weston-Super-Mare, with over 100 clinical services across ten sites. They offer care to the people of Bristol, Weston-Super-Mare and the South West, and have an international reputation for cardiac surgery, paediatric services, oncology and bone marrow transplantation. They are the largest centre for medical training and research in the South West.