2026 Southeastern Residency Conference

Angiotensin converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARBs) provide cardiovascular and renal protections across hypertension, chronic kidney disease, and heart failure populations, yet are often held during episodes of acute kidney injury (AKI). Optimal timing of post-AKI reinitiation remains uncertain. We aimed to compare outcomes among patients whose ACEi or ARB therapy was restarted at different times.   
 
We conducted a single center, retrospective cohort study of adult inpatients with AKI whose ACEi, ARB, or ARNI therapy was held ≥24 hours during hospitalization. Patients were categorized into 3 groups depending on whether therapy was restarted during hospitalization, restarted upon discharge, or not continued at discharge. The primary endpoint was complete renal recovery at 90 days. Secondary endpoints were AKI readmission rates within 90 days of discharge, cardiovascular events and all-cause mortality at 12 months, and time to treatment reinitiation in group 3. 
 
Among 148 patients (Group 1, n=41; Group 2, n=52; Group 3, n=55), there was no significant difference across groups in renal recovery at 90 days (73.2%, 59.6%, 67.3%, respectively; p=0.13). AKI readmission rates within 90 days (9.8%, 19.2%, 9.1%, respectively; p=0.25), cardiovascular events within 12 months (17.1%, 7.7%, 18.2%, respectively; p=0.22), and all-cause mortality within 12 months (12.2%, 5.8%, 7.3%, respectively; p=0.53) were similar across groups. Median (SD) time to reinitiation in group 3 was 60 ±94 days (p=0.049). 
 
Early reinitiation of ACEi or ARB after AKI did not worsen renal recovery at 90 days or increase adverse events. These findings support timely reinitiation with appropriate monitoring.