The Effect of Renin-Angiotensin-Aldosterone System Blockade Medications on Contrast-Induced Nephropathy in Patients Undergoing Coronary Angiography: A Meta-Analysis

Abstract

BackgroundContrast-induced nephropathy (CIN) is the main complication of contrast media administration (CM) in patients undergoing coronary angiography (CAG) and percutaneous coronary intervention (PCI). There are inconsistent results in the literature regarding the effect of renin-angiotensin-aldosterone system (RAAS) blockers (angiotensin-converting enzyme inhibitors [ACEIs] and angiotensin receptor blockers [ARBs]) on CIN. We evaluated the association between the administration of ACEI/ARBs and CIN, as well as the effect of ACEI/ARBs on post-procedural changes in renal function index, in patients undergoing CAG.MethodsWe searched Pubmed, EMBASE, Cochrane Central Register of Controlled Trials and ClinicalTrials.gov for relevant studies. The primary search generated 893 potentially relevant articles. A total of 879 studies were excluded because they did not meet the selection criteria. Finally, 14 studies were eligible for inclusion. There were 7,288 patients that received ACEI/ARBs and 8,159 patients that received placebo or naive to ACEI/ARBs in the study. A random or a fixed effect model was used to calculate the pooled odd ratios (ORs).ResultsThe risk of CIN was significantly increased in the ACEI/ARBs group compared to the control group (OR= 1.50, 95%CI: 1.03-2.18, P =0.03). The magnitude of association was significantly reinforced in the observational studies (OR=1.84, 95%CI 1.19-2.85, P=0.006) but not in the randomized controlled trials (OR=0.88, 95%CI 0.41-1.90 P=0.74). The summary adjusted OR of 4 observational studies was 1.56 (95%CI 1.25-1.94, P<0.0001) and was weaker than the unadjusted OR.ConclusionsAlthough there is some evidence to suggest that the administration of RAAS blockers was associated with the increased risk of CIN in patients undergoing CAG, the robustness of our study remains weak. The results are based on small observational studies and need further validation.

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) cardiologists

“…Contrary to these data are several studies—both prospective and retrospective which have shown increased rates of AKI following contrast angiography on a background of RAS blockade therapy . Currently, the management of RAS antagonists before angiography remains an area of clinical equipoise and the results of the present survey support this uncertainty .…”

Contemporary Practice Patterns Related to the Risk of Acute Kidney Injury in the Catheterization Laboratory: Results From an International Survey of Society of Cardiovascular Angiography and Intervention (Scai) Cardiologists

“…Contrary to these data are several studies-both prospective and retrospective which have shown increased rates of AKI following contrast angiography on a background of RAS blockade therapy [23,24]. Currently, the management of RAS antagonists before angiography remains an area of clinical equipoise and the results of the present survey support this uncertainty [25,26].…”

“…A 20-question online survey based on a modified Likert scale was sent out via email to the Society of Cardiovascular Angiography and Intervention (SCAI) member cardiologists during the time period between April 6, 2015 and April 26,2015. Subsequent to the initial solicitation, two reminder emails were sent.…”

Effect of Enalapril and Folic Acid Tablet on Contrast-induced Nephropathy in Patients with Mild Renal Insufficiency

“…Koza et al [17] compared the effect of long-term use of ACEI /ARB on CIN, which showed that the incidence of CIN was significantly higher in ACEI/ARB group than that in non-ACEI/ARB group. Wu et al [6] meta-analysis included large scale studies published recently (7288 patients received ACEI/ARB while 8,159 patients received placebo or were naive to ACEI/ARB), serving to potentially challenge some of the concerns that the administration of RAAS blockers protects against the development of CIN. The magnitude of association was significantly reinforced in the observational studies (OR=1.84, 95% CI: 1.19-2.85, P=0.006) but not in the randomized controlled trials (OR=0.88, 95% CI: 0.41-1.90 P=0.74).…”

“…Therefore, how to effectively reduce the risk of CIN in patients with CAD and renal insufficiency remains to be further studied. Currently, the role of angiotensin converting enzyme inhibitor (ACEI) or angiotensin receptor antagonist (ARB) in CIN is paradoxical due to important differences in study design and study participant characteristics [5][6][7].…”