title: Effect of renin-angiotensin-aldosterone system blockade therapy on incidence of contrast-induced nephropathy in patients with chronic kidney disease.
abstract: BACKGROUND
  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.
  
  
  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.affiliation: Division of Nephrology, Department of Medicine, Hershey Medical Center, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA.
authors.forename: Christin
authors.initials: C
authors.lastname: Spatz
authors.forename: Lawand
authors.initials: L
authors.lastname: Saadulla
authors.forename: Apurva
authors.initials: A
authors.lastname: Lapsiwala
authors.forename: Amin
authors.initials: A
authors.lastname: Parhizgar
authors.forename: Nasrollah
authors.initials: N
authors.lastname: Ghahramani
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000517:prevention & control; D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000009:adverse effects*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects*; D006328:Cardiac Catheterization; D003287:Contrast Media / Q000009:adverse effects*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007472:Iohexol / Q000009:adverse effects; D008297:Male; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D012084:Renin-Angiotensin System / Q000187:drug effects; D012189:Retrospective Studies; D012307:Risk Factors; D014283:Triiodobenzoic Acids / Q000009:adverse effects
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D003287:Contrast Media; D014283:Triiodobenzoic Acids; D007472:Iohexol; C044834:iodixanol