title: The effect of withdrawal of ACE inhibitors or angiotensin receptor blockers prior to coronary angiography on the incidence of contrast-induced nephropathy.
abstract: BACKGROUND
  The effect of continuing or discontinuing chronic angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) therapy prior to coronary angiography on the incidence of contrast-induced nephropathy (CIN) is not clear. We undertook a randomized trial to evaluate the effect of withdrawing ACEIs or ARBs 24 h prior to coronary angiography on the incidence of CIN associated with coronary angiography.
  
  
  METHODS
  A total of 220 patients with chronic kidney disease (CKD) stages 3-4 (glomerular filtration rate 15-60 ml/min/1.73 m2) on ACEI or ARB therapy were randomized before angiography to either ACEI/ARB continuation group or discontinuation group. A third group of patients with CKD stages 3-4 but not on angiotensin blockade therapy were also followed. The primary outcome measure was the incidence of CIN defined by a rise in serum creatinine by 25% or 0.5 mg/dl (44 micromol/l) from baseline.
  
  
  RESULTS
  There was no statistically significant difference in the incidence of CIN between the three groups (P=0.66). The incidences were 6.2%, 3.7%, and 6.3% for the continuation, discontinuation, and angiotensin blockade naïve group, respectively. There was also no significant difference found between the groups in mean serum creatinine and glomerular filtration rate values at baseline and post contrast administration.
  
  
  CONCLUSIONS
  Withholding ACEIs and ARBs 24 h before coronary angiography does not appear to influence the incidence of CIN in stable patients with CKD stages 3-4.
authors.affiliation: Division of Nephrology, Lenox Hill Hospital, 130 E 77th Street, 5th Floor, New York, NY 10021, USA. jrosenstock@lenoxhill.net
authors.forename: Jordan L
authors.initials: JL
authors.lastname: Rosenstock
authors.forename: Robert
authors.initials: R
authors.lastname: Bruno
authors.forename: Jin K
authors.initials: JK
authors.lastname: Kim
authors.forename: Lev
authors.initials: L
authors.lastname: Lubarsky
authors.forename: Robert
authors.initials: R
authors.lastname: Schaller
authors.forename: Georgia
authors.initials: G
authors.lastname: Panagopoulos
authors.forename: Maria V
authors.initials: MV
authors.lastname: DeVita
authors.forename: Michael F
authors.initials: MF
authors.lastname: Michelis
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D047228:Angiotensin II Type 1 Receptor Blockers / Q000008:administration & dosage*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage*; D003287:Contrast Media / Q000009:adverse effects*; D017023:Coronary Angiography; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D015994:Incidence; D007674:Kidney Diseases / Q000139:chemically induced*; D007676:Kidney Failure, Chronic / Q000150:complications*; D008297:Male
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D003287:Contrast Media; D003404:Creatinine