title: Is administration of preoperative angiotensin-converting enzyme inhibitors important for renal protection after cardiac surgery?
abstract: OBJECTIVE
  There are various reasons for renal dysfunction after cardiac surgery; however, activation of the renin-angiotensin system has an important role following cardiac surgery. We investigated the effect of preoperative angiotensin-converting enzyme (ACE) inhibitors on renal functions after cardiovascular surgery.
  
  
  METHODS
  Three hundred sixty-six patients awaiting elective cardiac surgery were allocated to two groups, namely the treatment group, comprising the ACE inhibitor group (n = 186), and the control group, which was without ACE inhibitor (n = 180). The renal parameters [blood urea nitrogen, creatinine, creatinine clearance, and glomerular filtration rate (GFR)] and the need for dialysis were evaluated associated with renal functions between the two groups in the postoperative period.
  
  
  RESULTS
  After cardiac surgery, renal dysfunction requiring dialysis developed in 11 (3.8%) patients in the control group patients. There was no required dialysis in the treatment group (p < 0.05). As an indicator of renal dysfunction, the increase in creatinine and blood urea nitrogen levels and the decrease in GFR and creatinine clearance were higher in the control group (p < 0.05). The multivariate analysis indicated that therapy with ACE inhibitors was found to decrease the incidence of postoperative renal dysfunction (odds ratio, 1.07; 95% confidence interval, 0.45-2.50; p < 0.05). The other independent predictors were age, preoperative intra-aortic blood pump, hypertension, diabetes mellitus, and a left ventricular ejection fraction below 0.40.
  
  
  CONCLUSIONS
  Preoperative therapy with ACE inhibitors has an influence on renal functions. This study demonstrates that administration of ACE inhibitors provides better renal protection after cardiac surgery.
authors.affiliation: Department of Cardiovascular Surgery, Erzurum Regional Training and Research Hospital, Erzurum, Turkey.
authors.forename: Ozgur
authors.initials: O
authors.lastname: Dag
authors.forename: Mehmet Ali
authors.initials: MA
authors.lastname: Kaygin
authors.forename: Ahmet
authors.initials: A
authors.lastname: Aydin
authors.forename: Husnu Kamil
authors.initials: HK
authors.lastname: Limandal
authors.forename: Ümit
authors.initials: Ü
authors.lastname: Arslan
authors.forename: Adem
authors.initials: A
authors.lastname: Kiymaz
authors.forename: Nail
authors.initials: N
authors.lastname: Kahraman
authors.forename: Eyup Serhat
authors.initials: ES
authors.lastname: Calik
authors.forename: Bilgehan
authors.initials: B
authors.lastname: Erkut
mesh_terms: D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D011300:Preoperative Care; D017257:Ramipril / Q000627:therapeutic use*; D051437:Renal Insufficiency / Q000209:etiology / Q000517:prevention & control*; D012084:Renin-Angiotensin System; D012189:Retrospective Studies
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D017257:Ramipril