title: The lack of benefit of a combination of an angiotensin receptor blocker and calcium channel blocker on contrast-induced nephropathy in patients with chronic kidney disease.
abstract: OBJECTIVE
  Contrast-induced nephropathy (CIN) is a relatively common and serious complication, which occurs after the administration of contrast materials to patients. Although the pathophysiology of CIN is not exactly understood, ischemia of the medulla, oxidative stress, and direct toxicity of the contrast material are some of the factors that are implicated for the pathogenesis of CIN. To date, the only therapy that reduces the risk of CIN is volume expansion. There are conflicting results about the roles of angiotensin receptor blockers (ARB) and calcium channel blockers (CCB) in studies on CIN. For this reason the aim of this study was to compare the efficiency of the prophylactic use of amlodipine/valsartan plus hydration versus hydration only for the prevention of CIN in patients undergoing coronary angiography (CAG).
  
  
  METHODS
  We prospectively enrolled 90 patients whose baseline serum creatinine levels were under 2.1 mg/dL and who were scheduled for CAG. Patients were divided into two groups. Group I (n = 45), consisted of patients who received amlodipine/valsartan plus hydration, group II (n = 45) consisted of patients who received only hydration. The patients in group I were given amlodipine/valsartan 5/160 mg once a day for a total of 3 days, starting one day before CAG and continuing on the day of and the day after the procedure. A 1 mL/kg/h sodium chloride infusion was administered for a total of 24 h, starting 12 h before the procedure and 12 h after, in all patients. The baseline serum creatinine (Scre) level was obtained before the procedure and repeated 48 h after. CIN was defined as an increase of ≥0.5 mg/dL or an increase of >25% in baseline Scre on the second day after CAG.
  
  
  RESULTS
  The baseline clinical characteristics of the treatment groups were similar. Baseline Scre was 1.13 ± 0.33 in group I and 1.07 ± 0.23 mg/dL in group II (p = 0.31). There was a significant difference between the Scre levels 48 h after CAG between the two groups (1.18 ± 0.33-1.05 ± 0.23) (p = 0.03). The reason for this was the increase of Scre in group I. CIN occurred in 17.8% (8/45) of patients in group I and in 6.7% (3/45) of patients in group II (p = 0.197). In the diabetic subgroup, CIN occurred in 10.5% (2/19) of patients taking amlodipine/valsartan and in none of the patients in group II (p = 0.486). The Mehran scores of the patients who developed CIN were significantly higher than those patients who did not develop CIN.
  
  
  CONCLUSIONS
  Amlodipine/valsartan therapy plus hydration did not reduce the risk of CIN in chronic kidney disease (CKD) Stage 2 patients who underwent elective CAG using a low-osmolar nonionic contrast medium. This is because there was a decrease in the glomerular filtration rate (GFR) using the Levey Modification of Diet in Renal Disease (MDRD) formula in the amlodipine/valsartan group and CIN occurred at a higher frequency in this group; ARBs and CCBs may be withheld before CAG in high-risk patients.
authors: Department of Nephrology, Erciyes University Medical School, Kayseri, Turkey. drniluhan@gmail.com
authors: Nilufer
authors: N
authors: Oguzhan
authors: Havva
authors: H
authors: Cilan
authors: Murat
authors: M
authors: Sipahioglu
authors: Aydin
authors: A
authors: Unal
authors: Ismail
authors: I
authors: Kocyigit
authors: Feridun
authors: F
authors: Kavuncuoglu
authors: Tamer
authors: T
authors: Arikan
authors: Mahmut
authors: M
authors: Akpek
authors: Deniz
authors: D
authors: Elcik
authors: Omer
authors: O
authors: Sahin
authors: Ebru
authors: E
authors: Gulme
authors: Cigdem
authors: C
authors: Pala
authors: Bulent
authors: B
authors: Tokgoz
authors: Cengiz
authors: C
authors: Utas
authors: Abdurrahman
authors: A
authors: Oguzhan
authors: Oktay
authors: O
authors: Oymak
mesh_terms: D000368:Aged; D017311:Amlodipine / Q000008:administration & dosage / Q000627:therapeutic use*; D000068838:Amlodipine, Valsartan Drug Combination; D057911:Angiotensin Receptor Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D002121:Calcium Channel Blockers / Q000008:administration & dosage / Q000627:therapeutic use*; D003287:Contrast Media / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood*; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007674:Kidney Diseases / Q000139:chemically induced* / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000188:drug therapy*; D012965:Sodium Chloride / Q000008:administration & dosage / Q000627:therapeutic use*; D013777:Tetrazoles / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000068838:Amlodipine, Valsartan Drug Combination; D057911:Angiotensin Receptor Antagonists; D002121:Calcium Channel Blockers; D003287:Contrast Media; D004338:Drug Combinations; D013777:Tetrazoles; D017311:Amlodipine; D012965:Sodium Chloride; D003404:Creatinine