The Effect of Renin-Angiotensin-Aldosterone System Blockade on Contrast-Induced Acute Kidney Injury: A Propensity-Matched Study

Rim, Min Young; Ro, Han; Kang, Woong Chol; Kim, Ae Jin; Park, Hyeon-Su; Chang, Jae Hyun; Lee, Hyun Hee; Chung, Wookyung; Jung, Ji Yong

doi:10.1053/j.ajkd.2012.04.017

Cited by 64 publications

(62 citation statements)

References 22 publications

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“…Some studies (20,21) (although not all [22,23]) have shown that preexisting hypertension increases risk of AKI. More pervasive use of antihypertensives, specifically blockers of the reninangiotensin axis (24), may play a role in susceptibility to severe AKI among those undergoing high-risk procedures (25)(26)(27). Although the adult prevalence of hypertension in the United States has been stable in the past decade (28), the annual number of hospital discharges with hypertension as a listed diagnosis has increased from 2006 to 2010 (29,30).…”

Section: Discussionmentioning

confidence: 99%

Exploring Potential Reasons for the Temporal Trend in Dialysis-Requiring AKI in the United States

Hsu¹,

McCulloch

Heung

et al. 2016

Clinical Journal of the American Society of Nephrology

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Background and objectives The population incidence of dialysis-requiring AKI has risen substantially in the last decade in the United States, and factors associated with this temporal trend are not well known.Design, setting, participants, & measurements We conducted a retrospective cohort study using data from the Nationwide Inpatient Sample, a United States nationally representative database of hospitalizations from 2007 to 2009. We used validated International Classification of Diseases, Ninth Revision codes to identify hospitalizations with dialysis-requiring AKI and then, selected the diagnostic and procedure codes most highly associated with dialysis-requiring AKI in 2009. We applied multivariable logistic regression adjusting for demographics and used a backward selection technique to identify a set of diagnoses or a set of procedures that may be a driver for this changing risk in dialysis-requiring AKI.Results From 2007 to 2009, the population incidence of dialysis-requiring AKI increased by 11% per year (95% confidence interval, 1.07 to 1.16; P,0.001). Using backward selection, we found that the temporal trend in the six diagnoses, septicemia, hypertension, respiratory failure, coagulation/hemorrhagic disorders, shock, and liver disease, sufficiently and fully accounted for the temporal trend in dialysis-requiring AKI. In contrast, temporal trends in 15 procedures most commonly associated with dialysis-requiring AKI did not account for the increasing dialysis-requiring AKI trend. ConclusionsThe increasing risk of dialysis-requiring AKI among hospitalized patients in the United States was highly associated with the changing burden of six acute and chronic conditions but not with surgeries and procedures.

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Section: Discussionmentioning

confidence: 99%

Exploring Potential Reasons for the Temporal Trend in Dialysis-Requiring AKI in the United States

Hsu¹,

McCulloch

Heung

et al. 2016

Clinical Journal of the American Society of Nephrology

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“…Some investigations with captopril or perindopril demonstrated positive results while others did not [1,2,3,4,5,6]. Moreover, confusing data have been reported that discontinuation of renin-angiotensin-aldosterone system (RAAS) blockade in chronic users is associated with a lower rate of CIN [6,7,8,9]. The most common cause of renal insufficiency with the use of RAAS blockades is thought to result from an efferent arteriolar vasodilation causing a reduction of the glomerular filtration rate (GFR), especially in the state of reduced effective arterial volume, mainly due to volume depletion, low cardiac output in heart failure and over-use of diuretics.…”

Section: Introductionmentioning

confidence: 99%

“…Although there are theoretically opposite effects of RAAS blockade on renal function, these conflicting results might also largely come from the small sample size of each study, different definitions of CIN and variable study protocols, including patient characteristics and periprocedural hydration methods [1,2,3,4,5,6,7,8,9,10,11,12]. Therefore, we performed this meta-analysis to overcome the limitation of the small population size of each study.…”

Section: Introductionmentioning

confidence: 99%

The Impact of Renin-Angiotensin-Aldosterone System Blockade on Contrast-Induced Nephropathy: A Meta-Analysis of 12 Studies with 4,493 Patients

Lee

Park

et al. 2014

Cardiology

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Objectives: This meta-analysis investigated the impact of renin-angiotensin-aldosterone system (RAAS) blockade on the occurrence of contrast-induced nephropathy (CIN). Methods: Twelve studies comparing the use of RAAS blockade in a total of 4,493 patients undergoing a contrast-using procedure were included. The primary endpoint was the overall postprocedural incidence of CIN. Results: In the overall pooled analysis, there was no significant difference between the two groups, RAAS blockade ‘used' versus ‘not-used', in the incidence of postprocedural CIN in the random-effects model (OR 1.27, 95% CI 1.77-2.11, p = 0.351, I² = 61.9%). In the stratified analysis, however, for chronic RAAS blockade users, the continuation of the drug was significantly associated with a higher incidence of CIN compared with discontinuation (OR 2.06, 95% CI 1.62-2.61, p < 0.001, I² = 0.0%). A hazard of continuation was marked in a subgroup of older patients or in patients with chronic kidney disease. For drug-na9ve patients, however, administration of RAAS blockade before contrast procedures did not reduce the development of CIN significantly (OR 0.52, 95% CI 0.23-1.16, p = 0.108, I² = 34.2%). Conclusion: Discontinuation of RAAS blockade in chronic users is associated with a significantly lower incidence of CIN, whereas administration of RAAS blockade as a preventive measure for na9ve patients did not show a significant effect on the incidence of CIN. i 2014 S. Karger AG, Basel

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“…Hence, it is an important area of research to investigate the effects of using a RAAS blocker on the risk of AKI under certain circumstances. Our previous retrospective study showed that the use of a RAAS blocker during coronary angiography has harmful influence to increase the incidence of contrast-induced AKI (Rim et al 2012). Furthermore, the use of a RAAS blocker in a perioperative cardiovascular surgery setting may increase the incidence of AKI (Cittanova et al 2001;Arora et al 2008).…”

Section: Discussionmentioning

confidence: 99%

Renin-Angiotensin-Aldosterone System Blockade in Critically Ill Patients Is Associated with Increased Risk for Acute Kidney Injury

Lim

Lee

Kim

et al. 2016

Tohoku J. Exp. Med.

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Acute kidney injury (AKI) is a major clinical problem and a predictor of outcomes in critically ill patients who frequently required treatments in the intensive care unit (ICU). Renin-angiotensin-aldosterone system (RAAS) blockers are commonly used for treating hypertension but demands caution because of accompanying illnesses including AKI. The aim of this study was to evaluate whether the use of RAAS blockers affected the incidence of AKI in ICU patients. From a total of 26,287 patients who were admitted to the ICU from January 2003 to December 2013 were included in the final analyses. The primary outcome was the incidence of AKI based on the prescription of RAAS blockers. The secondary outcomes were all-cause mortality. RAAS blocker users were more likely to develop AKI (P < 0.001) and remained an independent risk factor for AKI (odds ratio [OR], 1.56; 95% confidence interval [CI], 1.37-1.79; P < 0.001) after adjusting confounding factors. There was no significant difference in the cumulative 90-day survival rate between the RAAS blocker users and non-users (P = 0.381). However, the adjusted mortality risk associated with AKI was 1.38 (95% CI, 1.22 to 1.56; P < 0.001) and increased as the severity of AKI stage increased from 1 to 3: 1.17 (1.02 to 1.36), 1.77 (1.45 to 2.16), and 1.93 (1.55 to 2.41; P < 0.01 for the trend). RAAS blockers may have a harmful influence to increase the incidence of AKI and temporary withholding of these medications may deserve careful consideration in ICU patients.

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The Effect of Renin-Angiotensin-Aldosterone System Blockade on Contrast-Induced Acute Kidney Injury: A Propensity-Matched Study

Cited by 64 publications

References 22 publications

Exploring Potential Reasons for the Temporal Trend in Dialysis-Requiring AKI in the United States

Exploring Potential Reasons for the Temporal Trend in Dialysis-Requiring AKI in the United States

The Impact of Renin-Angiotensin-Aldosterone System Blockade on Contrast-Induced Nephropathy: A Meta-Analysis of 12 Studies with 4,493 Patients

Renin-Angiotensin-Aldosterone System Blockade in Critically Ill Patients Is Associated with Increased Risk for Acute Kidney Injury

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