Document Detail


Effect of renin-angiotensin-aldosterone system blockade therapy on incidence of contrast-induced nephropathy in patients with chronic kidney disease.
MedLine Citation:
PMID:  23146980     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
INTRODUCTION: The incidence of contrast-induced nephropathy (CIN) ranges between 10% and 50% among high-risk patients. Whether medications that affect rennin-angiotensin-aldosterone system (RAAS) have any impact on the development of CIN remains uncertain.
MATERIALS AND METHODS: We performed a retrospective study of patients with CKD stages 3 and 4 who were either on or off RAAS blockade therapy at the time of coronary angiography. Development of CIN was defined by a 25% increase of serum creatinine from baseline or an increase in serum creatinine by 0.5 mg/dL from baseline. Serum creatinine values were recorded before contrast exposure and for 5 days after coronary angiography.
RESULTS: A total of 178 patients with CKD who had coronary angiography during the study period were included, of whom 62 (35%) were on ACE inhibitors, 12 (7%) were on ARBs, and 1 (1%) was on combination of ACE inhibitors and ARBs. The estimated glomerular filtration rate was 44.0 ± 11.5 mL/min. The odds ratio of acute kidney failure on day 5 was 0.73 (95% confidence interval, 0.31 to 1.69) for the ACE inhibitors and 0.46 (95% confidence interval, 0.06 to 3.70) for ARBs. Multivariable analysis revealed the findings to be independent of demographic variables, comorbidities, type of contrast medium, and the prophylactic strategies.
CONCLUSIONS: Patients on RAAS blockade therapy before contrast exposure did not have an increased incidence of CIN. There was also no increased incidence of CIN with ACE inhibitors or ARBs in the subgroups at higher risk, such as those with diabetes mellitus.
Authors:
Christin Spatz; Lawand Saadulla; Apurva Lapsiwala; Amin Parhizgar; Nasrollah Ghahramani
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Iranian journal of kidney diseases     Volume:  6     ISSN:  1735-8604     ISO Abbreviation:  Iran J Kidney Dis     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-11-13     Completed Date:  2013-05-01     Revised Date:  2013-07-11    
Medline Journal Info:
Nlm Unique ID:  101316967     Medline TA:  Iran J Kidney Dis     Country:  Iran    
Other Details:
Languages:  eng     Pagination:  432-6     Citation Subset:  IM    
Affiliation:
Division of Nephrology, Department of Medicine, Hershey Medical Center, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA.
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MeSH Terms
Descriptor/Qualifier:
Acute Kidney Injury / chemically induced*,  prevention & control
Aged
Angiotensin II Type 1 Receptor Blockers / adverse effects*
Angiotensin-Converting Enzyme Inhibitors / adverse effects*
Cardiac Catheterization
Contrast Media / adverse effects*
Cross-Sectional Studies
Female
Humans
Iohexol / adverse effects
Male
Renal Insufficiency, Chronic / complications*
Renin-Angiotensin System / drug effects
Retrospective Studies
Risk Factors
Triiodobenzoic Acids / adverse effects
Grant Support
ID/Acronym/Agency:
K23 DK084300/DK/NIDDK NIH HHS; K23DK084300/DK/NIDDK NIH HHS
Chemical
Reg. No./Substance:
0/Angiotensin II Type 1 Receptor Blockers; 0/Angiotensin-Converting Enzyme Inhibitors; 0/Contrast Media; 0/Triiodobenzoic Acids; 66108-95-0/Iohexol; 92339-11-2/iodixanol
Comments/Corrections
Comment In:
Iran J Kidney Dis. 2013 Mar;7(2):166-7   [PMID:  23485545 ]
Iran J Kidney Dis. 2012 Nov;6(6):397-400   [PMID:  23146974 ]

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