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ACE inhibitor or angiotensin II receptor blocker use is a risk factor for contrast-induced nephropathy
Zia Umruddin1, Kyaw Moe, Keith Superdock
1The Lankenau Hospital and Institute for Medical Research, Wynnewood, Pennsylvania, USA. zmumar@hotmail.com
Insights
Angiotensin-converting enzyme inhibitors (ACEI) or angiotensin II receptor blockers (ARB) are independent risk factors for contrast-induced nephropathy (CIN). Discontinuing ACEI or ARB 48 hours before radiocontrast exposure is recommended, especially for high-risk patients.
Area of Science:
- Cardiology
- Nephrology
- Pharmacology
Background:
- Contrast-induced nephropathy (CIN) is a significant complication following coronary angiography.
- The role of renin-angiotensin-aldosterone system inhibitors, specifically ACEI or ARB, in CIN development requires further clarification.
Purpose of the Study:
- To evaluate the association between the use of ACEI or ARB and the incidence of CIN in patients undergoing coronary angiography.
- To identify ACEI or ARB as potential risk factors for CIN.
Main Methods:
- A retrospective case-control study involving 201 patients undergoing coronary angiography.
- Patients were divided into a CIN group (n=96) and a control group (n=105), matched for key clinical variables.
- CIN was defined as a serum creatinine increase >25% within 48 hours of contrast exposure.
Main Results:
- The overall incidence of CIN was 4.55%.
- Patients in the CIN group were significantly more likely to be on chronic ACEI or ARB use (58.3%) compared to the control group (34.3%) (p<0.001).
- ACEI or ARB use was associated with an odds ratio of 2.68 for developing CIN.
Conclusions:
- Chronic use of ACEI or ARB is an independent risk factor for developing CIN.
- Discontinuation of ACEI or ARB 48 hours prior to radiocontrast administration may reduce CIN risk, particularly in patients with multiple risk factors.
Background:
The aim of the present study was to assess the influence of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) use on the incidence of contrast-induced nephropathy (CIN) in patients undergoing coronary angiography.
Methods:
A retrospective case control study was conducted on a total of 201 patients divided into 2 groups (CIN group and control group). CIN was defined as an increase in serum creatinine by more than 25% from baseline within 48 hours of radiocontrast exposure. The CIN group had 96 patients, and the control group had 105 patients. The 2 groups were matched for variables such as age, sex, weight, baseline serum creatinine, diabetes, dye load, use of diuretics, statins and preprocedure prophylactic measures for CIN.
Results:
The incidence of CIN was found to be 4.55%. The CIN group had 96 patients out of which 56 patients (58.3%) were on chronic ACEI or ARB, while the control group had 105 patients, but only 36 of patients (34.3%) were on ACEI or ARB (p<0.001).The odds ratio for development of CIN with respect to ACEI or ARB use was 2.68 (95% confidence interval, 1.51-4.76).
Conclusion:
Use of ACEI or ARB is an independent risk factor for developing CIN. It is reasonable to discontinue their use 48 hours prior to exposure to radiocontrast agents, especially in patients with multiple risk factors.
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