ACE-I/ARB therapy prior to contrast exposure: what should the clinician do?

Area of Science:

• Nephrology
• Radiology
• Cardiology

Background:

• Contrast-induced nephropathy (CIN) is a leading cause of acute kidney injury worldwide.
• CIN contributes to significant morbidity, mortality, and increased healthcare costs.
• Many patients at risk for CIN are treated with ACE-Is or ARBs for cardiovascular and renal benefits.

Purpose of the Study:

• To review current evidence regarding ACE-I/ARB therapy in patients undergoing contrast media procedures.
• To provide recommendations on whether to continue or discontinue ACE-Is and ARBs before contrast exposure.

Main Methods:

• Systematic review of existing literature on ACE-I/ARB use and CIN.
• Analysis of clinical trial data and observational studies.
• Synthesis of evidence to inform clinical practice guidelines.

Main Results:

• Evidence regarding the impact of ACE-Is/ARBs on CIN risk is conflicting.
• Some studies suggest a potential protective effect, while others indicate an increased risk or no significant difference.
• The decision to continue or hold these medications may depend on individual patient factors and procedural risks.

Conclusions:

• The management of ACE-I/ARB therapy before contrast media exposure requires careful consideration of individual patient profiles.
• Further high-quality research is needed to definitively clarify the role of ACE-Is and ARBs in preventing CIN.
• Clinical recommendations should balance the known benefits of ACE-Is/ARBs against the potential risks associated with contrast media administration.