title: Impact of renin-angiotensin-aldosterone system-blocking agents on the risk of contrast-induced acute kidney injury: a prospective study and meta-analysis.
abstract: OBJECTIVE
  We sought to assess the impact of the pretreatment with angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) for coronary intervention on the risk of contrast-induced acute kidney injury (CI-AKI) after 72-hour postcontrast administration, together with a comprehensive meta-analysis in this aspect.
  
  
  RESULTS
  In this prospective study, 401 patients referred for percutaneous coronary intervention were enrolled with 134 patients in non-renin-angiotensin-aldosterone system group, 204 patients in ACEIs group and 63 patients in ARBs group. For further meta-analysis, articles were identified through PubMed, EMBASE, Wanfang, and VIP. Data extraction and study quality were assessed in duplicate. Altogether, 14 qualified trials (including this prospective study) with 1960 patients taking ACEIs or ARBs and 1457 patients receiving no renin-angiotensin-aldosterone system blockers were analyzed. There was an overall 1.28-fold increased risk for CI-AKI in patients taking ACEIs or ARBs (odds ratio [OR] = 1.28; 95% confidence interval [CI], 0.79-2.09; P = 0.315). Overall changes in serum creatinine, estimated GFR, and blood urea nitrogen were also nonsignificant. Subgroup analyses identified a significantly increased risk for CI-AKI in patients taking ARBs (OR = 3.31; 95% CI, 1.89-5.78; P < 0.0005), and no significance was observed for patients taking ACEIs (OR = 0.86; 95% CI, 043-1.72; P = 0.664). Also, patients taking ARBs had serum creatinine markedly increased by 0.05 mg/dL (95% CI, 0.02-0.09; P = 0.005).
  
  
  CONCLUSIONS
  The findings of this meta-analysis provide clear evidence for a deleterious impact of ARBs on the development of CI-AKI.
authors.affiliation: *Department of Cardiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China; and †State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Feng
authors.initials: F
authors.lastname: Peng
authors.forename: Jinzi
authors.initials: J
authors.lastname: Su
authors.forename: Jinxiu
authors.initials: J
authors.lastname: Lin
authors.forename: Wenquan
authors.initials: W
authors.lastname: Niu
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced / Q000175:diagnosis / Q000517:prevention & control*; D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000009:adverse effects*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects*; D016009:Chi-Square Distribution; D003287:Contrast Media / Q000009:adverse effects*; D017023:Coronary Angiography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention; D011446:Prospective Studies; D015641:Radiography, Interventional / Q000009:adverse effects*; D012084:Renin-Angiotensin System / Q000187:drug effects*; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D003287:Contrast Media