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Impact of Angiotensin-Converting Enzyme Inhibitors/Angiotensin Receptor Blockers on Renal Function in Chronic Kidney

Arunee T Motes1, Praveen Ratanasrimetha2, Sariya Wongsaengsak1

  • 1Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, USA.

Cureus
|February 25, 2021
PubMed

Insights

Continuing angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARB) with coronary angiography did not significantly impact kidney function in patients with chronic kidney disease (CKD). This study found no major association with acute kidney injury (AKI) post-procedure.

Area of Science:

  • Cardiology
  • Nephrology
  • Radiology

Background:

  • Cardiac catheterization and coronary angiography use contrast agents that can cause acute kidney injury (AKI).
  • Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARB) are common for cardiovascular and renal protection.
  • Renin-angiotensin-aldosterone system inhibitors, including ACE inhibitors/ARBs, carry a risk of inducing AKI.

Purpose of the Study:

  • To evaluate the impact of continuing ACE inhibitors/ARBs on renal function in patients with chronic kidney disease (CKD) undergoing coronary angiography.
  • To determine the association between ACE inhibitor/ARB use and the incidence of contrast-induced nephropathy.

Main Methods:

  • Retrospective analysis of 116 patients with CKD stages 2-5 who underwent coronary angiography.
  • Collected data on serum creatinine levels pre- and post-angiography.
  • Assessed AKI based on standard criteria: ≥0.3 mg/dl increase in SCr within 48 hours, or SCr ≥1.5 times baseline.

Main Results:

  • AKI occurred in 16.4% of patients based on the ≥0.3 mg/dl SCr increase criterion.
  • Using the SCr ≥1.5 times baseline criterion, AKI developed in 1.7% on day 1, 3.5% on day 2, and 6.0% on day 3.
  • Six patients had ACE inhibitor discontinuation and one had ARB discontinuation prior to the procedure.

Conclusions:

  • Continuation of ACE inhibitors/ARBs did not demonstrate a significant association with changes in renal function one month post-angiography.
  • The findings suggest that ACE inhibitors/ARBs can likely be continued safely in CKD patients undergoing coronary angiography.
  • Further research may be warranted to confirm these findings in larger cohorts.
Abstract

Keywords:
angiotensin receptor blockersangiotensin-converting enzyme inhibitorscontrast-induced acute kidney injurycoronary angiography

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