Effect of Angiotensin-Converting Enzyme Inhibitors in Contrast-Induced Nephropathy: A Meta-Analysis

Abstract

Aims: The purpose of this study was to evaluate the effect of angiotensin-converting enzyme inhibitors (ACEIs) on contrast-induced nephropathy (CIN) in patients undergoing coronary angiography or percutaneous coronary intervention (PCI). Methods: We searched the Medline, Embase, Cochrane Library, China National Knowledge Infrastructure, Chongqing VIP database and Wanfang database up to December 2014. Pooled risk ratios (RRs) or weighted mean difference (WMD) with their 95% CIs for the CIN incidence, serum creatinine (SCr), estimated glomerular filtration rate (eGFR) and blood urea nitrogen (BUN) of the patients were collected and calculated using the software Review Manager 5.2. Results: A total of 12 separate studies including 1,868 patients (1,011 ACEI cases and 857 controls) were considered in the meta-analysis. The overall RR of the incident CIN in the ACEI group vs. the control group was 0.95 (95% CI 0.57-1.58), and the total WMDs of the ΔSCr, ΔeGFR and ΔBUN were -0.01 (95% CI -0.04 to 0.02), 5.71 (95% CI -0.66 to 12.09) and 0.78 (95% CI -0.16 to 1.73), respectively. Besides, the RR of CIN incidence in the captopril group vs. the control group was 0.72 (95% CI 0.25-2.05, p = 0.54), and the pooled WMD of the ΔSCr was -0.13 (95% CI -0.21 to -0.06, p < 0.01). Conclusion: This meta-analysis suggests that ACEIs administration has no significant influence in the CIN of patients undergoing coronary angiography or PCI; however, captopril might have the potential to prevent CIN.

Contrast-induced acute kidney injury: A review of practical points

“…We think that, cessation of ACEI/ARB treatments for only 1 d before the procedure might not be adequate because renal hemodynamic effects of these drugs might last longer. In a very recent meta-analysis, ACEI use was not found to have a significant effect on the CI-AKI in patients undergoing PTCA[76]. In summary, there is not enough evidence to recommend withholding or continuing ACEI/ARB treatments before contrast-enhanced imaging.…”

Guideline on the use of iodinated contrast media in patients with kidney disease 2018

“…In recent years, 3 meta-analyses/systematic reviews were reported that examined the incidence of CIN in coronary angiography (CAG) (including arterioplasty). Zhou et al reported [18] that the incidence of CIN was 7.9% under the continuous administration of ACE inhibitors (control: 8.2%, RR 0.95, and 95% CI 0.57-1.58). Jo et al [19] reported that the use of RAS inhibitors was not a significant risk factor (OR 1.27, 95% CI 0.77-2.07, p = 0.351) in the meta-analysis.…”

Diagnostic use of contrast medium and the kidney: A challenge or a ghost?

“…No data are available about protective or deleterious effects of Angiotenin converting enzyme (ACE) inhibitors and Angiotensin Receptor Blockers (ARBs) in patients undergoing a contrast-enhanced CT. Data from interventional procedures in patients with coronary disease, also showing conflicting results, 56,57 should not be taken as a paradigm. Theoretical favorable effects by means of Angiotensin converting enzyme 2 (ACE2)-mediated vasodilation and Angiotensin II (AT2) receptor mediated Nitric oxyde sinthase (NOS) upregulation may be counterbalanced by renal hypo-perfusion and reduction of glomerular filtration pressure, leading to detrimental effect on CIAKI occurrence in these patients.…”