The effects of chronic usage of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers on contrast-induced nephropathy in low-risk patients

Abstract

Objective: There is conflicting data about the role of renin-angiotensin-aldosterone system (RAAS) blockers in contrast-induced nephropathy (CIN) pathophysiology. In this study, we aimed to investigate the effects of chronic usage of RAAS blocker drugs on development of CIN in low risk patients. Methods: Study was designed as a prospective cohort study. A total of 295 patients were enrolled in the study. Study population was consisted of three subgroups according to prior usage of RAAS blockers: no RAAS blocker group (n=95), angiotensin-converting enzyme inhibitor (ACEI) group (n=106), angiotensin receptor blocker (ARB) group (n=94). CIN was defined as an increase of ≥25% in creatinine over the baseline value or 0.5 mg/dL rise within 48-72 h of angiography. Mehran score was calculated for each patient. Baseline variables and percentage of CIN were compared with ANOVA, Mann-Whitney U, Kruskal-Wallis and Pearson Chi-square tests between groups. In order to determine the independent predictors of CIN, binary logistic regression analyses were performed. Results: CIN occurred in 18 patients (17.0%) in the ACEI group, 17 patients (18.1%) in ARB group and 7 patients (7.4%) in the no RAAS group. CIN occurrence was significantly higher in RAAS than no RAAS group (17.5% vs. 7.4%, p=0.01). Chronic RAAS blocker administration was an independent predictor of CIN (OR=2.69; 95% CI: 1.025-7.067; p=0.04). Mehran score was the only other independent predictor for CIN (OR=1.15; 95% CI: 1.019-1.310; p=0.02).

The Impact of Renin-Angiotensin-Aldosterone System Blockade on Contrast-Induced Nephropathy: A Meta-Analysis of 12 Studies with 4,493 Patients

“…1) [1,2,3,4,5,6,7,8,9,10,11,12]. These 12 studies included a total of 4,493 adult patients [administration or continuation of ACEI/ARB: 2,362 (52.6%); control/placebo or discontinuation of ACEI/ARB: 2,131 (47.4%)].…”

“…Assessment of ‘risk of bias' is summarized in online supplementary table 1. Among the 12 studies, 8 were RCTs [1,2,3,4,5,10,11,12] and 4 were retrospective [7,8] or prospective registry analyses [6,9]. Among the 8 RCTs, 6 evaluated the effect of ACEI/ARB as a preventive measure of postprocedural occurrence of CIN compared with placebo or a control group [1,2,3,4,5,11], and the other 2 evaluated the impact of preprocedural discontinuation of ACEI/ARB versus continuation of the medications on the postprocedural occurrence of CIN [10,12].…”

“…Some investigations with captopril or perindopril demonstrated positive results while others did not [1,2,3,4,5,6]. Moreover, confusing data have been reported that discontinuation of renin-angiotensin-aldosterone system (RAAS) blockade in chronic users is associated with a lower rate of CIN [6,7,8,9]. The most common cause of renal insufficiency with the use of RAAS blockades is thought to result from an efferent arteriolar vasodilation causing a reduction of the glomerular filtration rate (GFR), especially in the state of reduced effective arterial volume, mainly due to volume depletion, low cardiac output in heart failure and over-use of diuretics.…”

“…Although there are theoretically opposite effects of RAAS blockade on renal function, these conflicting results might also largely come from the small sample size of each study, different definitions of CIN and variable study protocols, including patient characteristics and periprocedural hydration methods [1,2,3,4,5,6,7,8,9,10,11,12]. Therefore, we performed this meta-analysis to overcome the limitation of the small population size of each study.…”

Effects of Renin–Angiotensin–Aldosterone System Blockers and Renoprotective Regimens on Contrast-Induced Nephropathy

“…3 Following these recommendations, we started hydration with isotonic saline and administered highdose statins for our patients. The association between chronic use of renin-angiotensin-aldosterone system blockers and CIN is not well established; there is only 1 small observational study 4 on this issue, so we did not use this information in our study. 2 As expected, the frequency of diabetes mellitus and hypertension was higher in the CIN group as expected and we included these variables in multivariate analysis with the platelet to lymphocyte ratio (PLR).…”