ACE inhibitor or angiotensin II receptor blocker use is a risk factor for contrast-induced nephropathy.
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).


CONCLUSIONS
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.
The Lankenau Hospital and Institute for Medical Research, Wynnewood, Pennsylvania, USA. zmumar@hotmail.com
Zia
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Umruddin
Kyaw
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Moe
Keith
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Superdock
D000368:Aged; D000369:Aged, 80 and over; D047228:Angiotensin II Type 1 Receptor Blockers / Q000009:adverse effects*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects*; D015415:Biomarkers / Q000097:blood; D003287:Contrast Media / Q000009:adverse effects*; D017023:Coronary Angiography / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D015994:Incidence; D007674:Kidney Diseases / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010414:Pennsylvania / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D015854:Up-Regulation
D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D015415:Biomarkers; D003287:Contrast Media; D003404:Creatinine