The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
권호 표지
DOI QR코드

DOI QR Code

Effect of renin-angiotensin-system blockers on contrast-medium-induced acute kidney injury after coronary angiography

  • Goo, Ja-Jun (Department of Internal Medicine, Maryknoll Medical Center) ;
  • Kim, Jae-Joon (Department of Internal Medicine, Maryknoll Medical Center) ;
  • Kang, Ji-Hoon (Department of Internal Medicine, Maryknoll Medical Center) ;
  • Kim, Kyoung-Nyoun (Department of Internal Medicine, Maryknoll Medical Center) ;
  • Byun, Ki-Sup (Department of Internal Medicine, Maryknoll Medical Center) ;
  • Kim, Mi-Kyung (Department of Internal Medicine, Inje University College of Medicine) ;
  • Kim, Tae-Ik (Department of Internal Medicine, Maryknoll Medical Center)
  • Received : 2013.01.11
  • Accepted : 2013.09.11
  • Published : 2014.03.01
⟨ Previous Next ⟩

Abstract

Background/Aims: 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.

Keywords

References

  1. Laville M, Juillard L. Contrast-induced acute kidney injury: how should at-risk patients be identified and managed? J Nephrol 2010;23:387-398.
  2. Kiski D, Stepper W, Brand E, Breithardt G, Reinecke H. Impact of renin-angiotensin-aldosterone blockade by angiotensin-converting enzyme inhibitors or AT-1 blockers on frequency of contrast medium-induced nephropathy: a post-hoc analysis from the Dialysis-versus- Diuresis (DVD) trial. Nephrol Dial Transplant 2010;25:759-764. https://doi.org/10.1093/ndt/gfp582
  3. Morcos SK, Thomsen HS; European Society of Urogenital Radiology. European Society of Urogenital Radiology guidelines on administering contrast media. Abdom Imaging 2003;28:187-190. https://doi.org/10.1007/s00261-001-0186-5
  4. Mehta RL, Kellum JA, Shah SV, et al. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007;11:R31. https://doi.org/10.1186/cc5713
  5. Nikolsky E, Aymong ED, Dangas G, Mehran R. Radiocontrast nephropathy: identifying the high-risk patient and the implications of exacerbating renal function. Rev Cardiovasc Med 2003;4 Suppl 1:S7-S14. https://doi.org/10.1016/S1522-1865(03)00117-3
  6. Thomsen HS. European Society of Urogenital Radiology Guidelines on Contrast Media, Ver. 7.0. Heidelberg: European Society of Urogenital Radiology, 2008.
  7. Nyman U, Almen T, Aspelin P, Hellstrom M, Kristiansson M, Sterner G. Contrast-medium-Induced nephropathy correlated to the ratio between dose in gram iodine and estimated GFR in ml/min. Acta Radiol 2005;46:830-842. https://doi.org/10.1080/02841850500335051
  8. Nash K, Hafeez A, Hou S. Hospital-acquired renal insufficiency. Am J Kidney Dis 2002;39:930-936. https://doi.org/10.1053/ajkd.2002.32766
  9. Bartholomew BA, Harjai KJ, Dukkipati S, et al. Impact of nephropathy after percutaneous coronary interven-tion and a method for risk stratification. Am J Cardiol 2004;93:1515-1519. https://doi.org/10.1016/j.amjcard.2004.03.008
  10. Mehran R, Aymong ED, Nikolsky E, et al. A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: development and initial validation. J Am Coll Cardiol 2004;44:1393-1399.
  11. Persson PB, Tepel M. Contrast medium-induced nephropathy: the pathophysiology. Kidney Int Suppl 2006;(100):S8-S10.
  12. Louis BM, Hoch BS, Hernandez C, et al. Protection from the nephrotoxicity of contrast dye. Ren Fail 1996;18:639-646. https://doi.org/10.3109/08860229609047689
  13. Reinecke H, Fobker M, Wellmann J, et al. A randomized controlled trial comparing hydration therapy to additional hemodialysis or N-acetylcysteine for the prevention of contrast medium-induced nephropathy: the Dialysis-versus-Diuresis (DVD) Trial. Clin Res Cardiol 2007;96:130-139. https://doi.org/10.1007/s00392-007-0473-4
  14. Lewis EJ, Hunsicker LG, Bain RP, Rohde RD. The effect of angiotensin-converting-enzyme inhibition on diabetic nephropathy: the Collaborative Study Group. N Engl J Med 1993;329:1456-1462. https://doi.org/10.1056/NEJM199311113292004
  15. Toprak O, Cirit M, Bayata S, Yesil M, Aslan SL. The effect of pre-procedural captopril on contrast-induced nephropathy in patients who underwent coronary angiography. Anadolu Kardiyol Derg 2003;3:98-103.
  16. Lewis EJ, Hunsicker LG, Clarke WR, et al. Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes. N Engl J Med 2001;345:851-860. https://doi.org/10.1056/NEJMoa011303
  17. Swedberg K, Kjekshus J. Effects of enalapril on mortality in severe congestive heart failure: results of the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS). Am J Cardiol 1988;62:60A-66A.
  18. Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. The SOLVD Investigators. N Engl J Med 1991;325:293-302. https://doi.org/10.1056/NEJM199108013250501
  19. Toto RD. Renal insufficiency due to angiotensin-converting enzyme inhibitors. Miner Electrolyte Metab 1994;20:193-200.
  20. Christensen PK, Hansen HP, Parving HH. Impaired autoregulation of GFR in hypertensive non-insulin dependent diabetic patients. Kidney Int 1997;52:1369-1374. https://doi.org/10.1038/ki.1997.463
  21. Modif ication of Diet in Renal Disease Study Group. Short-term effects of protein intake, blood pressure, and antihypertensive therapy on glomerular filtration rate in the Modification of Diet in Renal Disease Study. J Am Soc Nephrol 1996;7:2097-2109.
  22. Dangas G, Iakovou I, Nikolsky E, et al. Contrast-induced nephropathy after percutaneous coronary interventions in relation to chronic kidney disease and hemodynamic variables. Am J Cardiol 2005;95:13-19. https://doi.org/10.1016/j.amjcard.2004.08.056
  23. Gupta RK, Kapoor A, Tewari S, Sinha N, Sharma RK. Captopril for prevention of contrast-induced nephropathy in diabetic patients: a randomised study. Indian Heart J 1999;51:521-526.
  24. Rim MY, Ro H, Kang WC, et al. The effect of renin-angiotensin- aldosterone system blockade on contrast-induced acute kidney injury: a propensity-matched study. Am J Kidney Dis 2012;60:576-582. https://doi.org/10.1053/j.ajkd.2012.04.017
  25. Tumlin J, Stacul F, Adam A, et al. Pathophysiology of contrast-induced nephropathy. Am J Cardiol 2006;98(6A):14K-20K.
  26. Gopalan PD. Contrast-induced acute kidney injury. South Afr J Anaesth Analg 2011;17:193-195.
  27. Perazella MA. Renal vulnerability to drug toxicity. Clin J Am Soc Nephrol 2009;4:1275-1283. https://doi.org/10.2215/CJN.02050309
  28. Weisbord SD, Palevsky PM. Strategies for the prevention of contrast-induced acute kidney injury. Curr Opin Nephrol Hypertens 2010;19:539-549. https://doi.org/10.1097/MNH.0b013e32833d42e3

Cited by

  1. Risk prediction models for contrast induced nephropathy: systematic review vol.351, pp.None, 2015, https://doi.org/10.1136/bmj.h4395
  2. Prevention Strategies of Contrast Medium Induced Nephropathy (CIN): A Review of the Current Literature vol.6, pp.3, 2014, https://doi.org/10.4236/ojneph.2016.63013
  3. Contemporary practice patterns related to the risk of acute kidney injury in the catheterization laboratory: Results from a survey of Society of Cardiovascular Angiography and Intervention (SCAI) card vol.89, pp.3, 2014, https://doi.org/10.1002/ccd.26628
  4. Effectiveness of contrast-associated acute kidney injury prevention methods; a systematic review and network meta-analysis vol.19, pp.1, 2018, https://doi.org/10.1186/s12882-018-1113-0
  5. Renin-angiotensin-aldosterone system blockade is associated with higher risk of contrast-induced acute kidney injury in patients with diabetes vol.12, pp.7, 2020, https://doi.org/10.18632/aging.102982