title: Effect of renin-angiotensin-system blockers on contrast-medium-induced acute kidney injury after coronary angiography.
abstract: OBJECTIVE
  With the increasing incidence of cardiovascular disease, angiocardiography using contrast-enhancing media has become an essential diagnostic and therapeutic tool, despite the risk of contrast-medium-induced acute kidney injury (CIAKI). CIAKI may be exacerbated by renin-angiotensin-system (RAS) blockers, which are also used in a variety of cardiovascular disorders. This study evaluated the effects of RAS blockade on CIAKI after coronary angiography.
  
  
  METHODS
  Patients who underwent coronary angiography in our hospital between May 2009 and July 2011 were reviewed. Serum creatinine levels before and after coronary angiography were recorded. CIAKI was diagnosed according to an increase in serum creatinine > 0.5 mg/dL or 25% above baseline.
  
  
  RESULTS
  A total of 1,472 subjects were included in this study. Patients taking RAS blockers were older, had a higher baseline creatinine level, lower estimated glomerular filtration rate (eGFR), and had received a greater volume of contrast medium. After propensity score matching, no difference was observed between the RAS (+) and RAS (.) groups. Multiple logistic regression identified RAS blockade, age, severe heart failure, contrast volume used, hemoglobin level, and eGFR as predictors of CIAKI. Multiple logistic regression after propensity matching showed that RAS blockade was associated with CIAKI (odds ratio, 1.552; p = 0.026).
  
  
  CONCLUSIONS
  This study showed that the incidence of CIAKI was increased in patients treated with RAS blockers.
authors.affiliation: Department of Internal Medicine, Maryknoll Medical Center, Busan, Korea.
authors.forename: Ja-Jun
authors.initials: JJ
authors.lastname: Goo
authors.affiliation: Department of Internal Medicine, Maryknoll Medical Center, Busan, Korea.
authors.forename: Jae-Joon
authors.initials: JJ
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Maryknoll Medical Center, Busan, Korea.
authors.forename: Ji-Hoon
authors.initials: JH
authors.lastname: Kang
authors.affiliation: Department of Internal Medicine, Maryknoll Medical Center, Busan, Korea.
authors.forename: Kyoung-Nyoun
authors.initials: KN
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Maryknoll Medical Center, Busan, Korea.
authors.forename: Ki-Sup
authors.initials: KS
authors.lastname: Byun
authors.affiliation: Department of Internal Medicine, Inje University College of Medicine, Busan, Korea.
authors.forename: Mi-kyung
authors.initials: MK
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Maryknoll Medical Center, Busan, Korea.
authors.forename: Tae-Ik
authors.initials: TI
authors.lastname: Kim
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000009:adverse effects*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects*; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D003287:Contrast Media / Q000009:adverse effects*; D017023:Coronary Angiography / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006801:Humans; D015994:Incidence; D007668:Kidney / Q000187:drug effects* / Q000503:physiopathology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D057216:Propensity Score; D012084:Renin-Angiotensin System / Q000187:drug effects*; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D015415:Biomarkers; D003287:Contrast Media; D003404:Creatinine
keywords: Acute kidney injury; Coronary angiography; Renin angiotensin system