Preoperative Angiotensin-Converting Enzyme Inhibitors and Acute Kidney Injury After Coronary Artery Bypass Grafting

Benedetto, Umberto; Sciarretta, Sebastiano; Roscitano, Antonino; Fiorani, Brenno; Refice, Simone; Angeloni, Emiliano; Sinatra, Riccardo

doi:10.1016/j.athoracsur.2008.06.018

Cited by 98 publications

(52 citation statements)

References 23 publications

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“…Our findings regarding the prognostic utility of angiotensinogen as a biomarker of AKI suggest that the RAS could be mechanistically involved in AKI. This is supported by observational studies that have noted an association between pharmacologic inhibition of the RAS and risk of developing AKI, although there are conflicting reports in the literature (31)(32)(33)(34). The ACE II genotype has been associated with increased risk of AKI in the ICU (35).…”

Section: Discussionsupporting

confidence: 55%

Urinary Angiotensinogen and Risk of Severe AKI

Alge

Karakala

Neely

et al. 2013

Clinical Journal of the American Society of Nephrology

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SummaryBackground Biomarkers of AKI that can predict which patients will develop severe renal disease at the time of diagnosis will facilitate timely intervention in populations at risk of adverse outcomes.Design, setting, participants, & measurements Liquid chromatography/tandem mass spectrometry was used to identify 30 potential prognostic urinary biomarkers of severe AKI in a group of patients that developed AKI after cardiac surgery. Angiotensinogen had the best discriminative characteristics. Urinary angiotensinogen was subsequently measured by ELISA and its prognostic predictive power was verified in 97 patients who underwent cardiac surgery between August 1, 2008 and October 6, 2011.Results The urine angiotensinogen/creatinine ratio (uAnCR) predicted worsening of AKI, Acute Kidney Injury Network (AKIN) stage 3, need for renal replacement therapy, discharge .7 days from sample collection, and composite outcomes of AKIN stage 2 or 3, AKIN stage 3 or death, and renal replacement therapy or death. The prognostic predictive power of uAnCR was improved when only patients classified as AKIN stage 1 at the time of urine sample collection (n=79) were used in the analysis, among whom it predicted development of stage 3 AKI or death with an area under the curve of 0.81. Finally, category free net reclassification improvement showed that the addition of uAnCR to a clinical model to predict worsening of AKI improved the predictive power.Conclusions Elevated uAnCR is associated with adverse outcomes in patients with AKI. These data are the first to demonstrate the utility of angiotensinogen as a prognostic biomarker of AKI after cardiac surgery.

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Section: Discussionsupporting

confidence: 55%

Urinary Angiotensinogen and Risk of Severe AKI

Alge

Karakala

Neely

et al. 2013

Clinical Journal of the American Society of Nephrology

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“…5- 7 Benedetto et al evaluated the effect of preoperative ACE inhibitors on the occurrence of postoperative AKI in a propensity-score-based analysis of 536 patients undergoing on-pump CABG. 5 The incidence of AKI was 6.4% in patients who received preoperative ACE inhibitors and 12.2% in patients who did not (P=0.02). The incidence of AKI requiring dialysis was 2.4% in the treatment group and 6.3% in controls (P=0.03).…”

Section: Article P 1852mentioning

confidence: 99%

Role of Renin-Angiotensin System Inhibitors in Patients Undergoing Off-Pump Coronary Artery Bypass Grafting

Kinoshita

Asai

2010

Circ J

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“…23) Benedetto and colleagues reported that preoperative ACEI reduced postoperative acute kidney injury almost in half, which suggests a protective effect of ACEI on renal perfusion during cardiopulmonary bypass. 24) In the present study, about 90% of patients were on ACEI and/or ARB postoperatively. It is yet to be determined how medical management affected postoperative survival or MACE.…”

Section: Discussionmentioning

confidence: 92%