title: ACE-I/ARB therapy prior to contrast exposure: what should the clinician do?
abstract: Contrast-induced nephropathy (CIN) is now one of the three leading causes of acute kidney injury in the world. A lot is known about the risk factors of CIN, yet it remains a major cause of morbidity, end stage renal disease, prolonged hospital stay, and increased costs as well as a high mortality. Many patients undergoing contrast-based radiological investigations are treated with angiotensin converting inhibitors (ACE-Is) or angiotensin receptor blockers (ARBs) for their cardiac and renal benefits and their known mortality benefits. However, controversy exists among clinicians as to whether ACE-Is and ARBs should be continued or discontinued prior to contrast media exposure. In this paper we review the current evidence on ACE-I/ARB therapy for patients undergoing procedures involving use of contrast media and provide recommendations as to whether these drugs should be continued or held prior to contrast exposure.
authors.affiliation: Makerere University College of Health Sciences, 7072 Kampala, Uganda.
authors.forename: Robert
authors.initials: R
authors.lastname: Kalyesubula
authors.affiliation: Makerere University College of Health Sciences, 7072 Kampala, Uganda.
authors.forename: Peace
authors.initials: P
authors.lastname: Bagasha
authors.affiliation: Section of Nephrology, Yale University School of Medicine, New Haven, CT 06520, USA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Perazella
mesh_terms: D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D003287:Contrast Media / Q000009:adverse effects*; D006282:Health Personnel; D006801:Humans; D007674:Kidney Diseases / Q000139:chemically induced; D020011:Protective Agents / Q000627:therapeutic use
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D003287:Contrast Media; D020011:Protective Agents