The effect of chronic usage of Renin-Angiotensin-Aldosterone System Blocking Agents on Incidence of Contrast-Induced Nephropathy in patients with Diabetes Mellitus and Renal Insufficiency. A Restropesctive Cohort Study
Background: This study was to investigate the effect of long term use of Renin-Angiotensin-Aldosterone System(RAAS) blocking agents on the incidence of Contrast-Induced Nephropathy(CIN) on patients with Diabetes Mellitus(DM) and renal insufficiency underwent Percutaneous Coronary Intervention (PCI).
Methods:A total 281 of subjects were included in this study and divided into two groups based on prior use of RAAS blocking agents (RAAS +, n = 146; RAAS -, n = 135). CIN was defined as an increase of â‰¥25% in creatinin over baseline value 48-72 hours after PCI.
Result: Total incidence of CIN was 14,95%. There was no difference in the incidence of CIN between 2 study groups (p = 0,952) and relatif risk for CIN was 1,02. Left Ventricular ejection Fraction (LVEF) â‰¤ 40 % (OR 2,300; 95% CI 1,028 â€“ 5,143; p = 0,043), anemia (OR 2,628; 95% CI 1,274 â€“ 5,422; p = 0,009) and Glomerular Filtration rate (GFR) pre PCI â‰¤ 60 mL/menit (OR 2,782; 95% CI 1,293 â€“ 5,987; p = 0,009) were important predictors of CIN.
Conclusion: Long term use of RAAS blocking agents do not increase the incidence of CIN on patients with DM and renal insufficiency underwent PCI.
2. Spatz C, Saadulla L, Lapsiwala A, Parhizgar A, Ghahramani N. Effect of renin-angiotensin-aldosterone system blockade therapy on incidence of contrast-induced nephropathy in patients with chronic kidney disease. Iran J Kidney Dis. 2012;6(6):432â€“6.
3. The OF, Nephrology OF. OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF NEPHROLOGY KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney Int [Internet]. 2012;2(1):i-iv; 1-138. Available from: http://www.kdigo.org/index.php
4. Evola S, Lunetta M, MacAione F, Fonte G, Milana G, Corrado E, et al. Risk factors for contrast induced nephropathy: A study among italian patients. Indian Heart J [Internet]. 2012;64(5):484â€“91. Available from: http://dx.doi.org/10.1016/j.ihj.2012.07.007
5. Solomon RJ, Mehran R, Natarajan MK, Doucet S, Katholi RE, Staniloae CS, et al. Contrast-induced nephropathy and long-term adverse events: Cause and effect? Clin J Am Soc Nephrol. 2009;4(7):1162â€“9.
6. K Gupta R, Kapoor A, Tewari S, Sinha N, Sharma R. Captopril for prevention of contrast-induced nephropathy in diabetic patients: A randomised study. Vol. 51, Indian heart journal. 1998. 521-526 p.
7. Cirit M, Toprak O, Yesil M, Bayata S, Postaci N, Pupim L, et al. Angiotensin-converting enzyme inhibitors as a risk factor for contrast-induced nephropathy. Nephron Clin Pract [Internet]. 2006;104(1):c20-27. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16685140
8. Baris N, Ozpelit E, Bilgin Dogan N, Kangul H, Gul S, Akdeniz B, et al. The effects of chronic usage of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers on contrast-induced nephropathy in low-risk patients. Anadolu Kardiyol Dergisi/The Anatol J Cardiol [Internet]. 2012;245â€“50. Available from: http://anatoljcardiol.com/jvi.aspx?un=AJC-67209
9. HÃ¶lscher B, Heitmeyer C, Fobker M, Breithardt G, Schaefer RM, Reinecke H. Predictors for contrast media-induced nephropathy and long-term survival: Prospectively assessed data from the randomized controlled Dialysis-Versus-Diuresis (DVD) trial. Can J Cardiol [Internet]. 2008;24(11):845â€“50. Available from: http://dx.doi.org/10.1016/S0828-282X(08)70193-4
10. Wong PCY, Li Z, Guo J, Zhang A. Pathophysiology of contrast-induced nephropathy. Int J Cardiol [Internet]. 2012;158(2):186â€“92. Available from: http://dx.doi.org/10.1016/j.ijcard.2011.06.115
11. Yacoub R, Patel N, Lohr JW, Rajagopalan S, Nader N, Arora P. Acute Kidney Injury and Death Associated With Renin Angiotensin System Blockade in Cardiothoracic Surgery: A Meta-analysis of Observational Studies. Am J Kidney Dis. 2013;62(6):1077â€“86.
12. Priestley JRC, Buelow MW, McEwen ST, Weinberg BD, Delaney M, Balus SF, et al. Reduced angiotensin II levels cause generalized vascular dysfunction via oxidant stress in hamster cheek pouch arterioles. Microvasc Res [Internet]. 2013;89:134â€“45. Available from: http://dx.doi.org/10.1016/j.mvr.2013.04.004
13. Xiong X ling, Jia R han, Yang D ping, Ding G hua. Irbesartan attenuates contrast media-induced NRK-52E cells apoptosis. Pharmacol Res. 2006;54(4):253â€“60.
14. Mehran R, Aymong ED, Nikolsky E, Lasic Z, Iakovou I, Fahy M, 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(7):1393â€“9.
15. Of D, Mellitus D. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2014;37(SUPPL.1):81â€“90.
16. Rosenstock JL, Bruno R, Kim JK, Lubarsky L, Schaller R, Panagopoulos G, et al. The effect of withdrawal of ACE inhibitors or angiotensin receptor blockers prior to coronary angiography on the incidence of contrast-induced nephropathy. Int Urol Nephrol. 2008;40(3):749â€“55.
17. Mccullough P a. Review CIN Consensus Working Panelâ€¯: Am J Cardiol. 2008;4â€“10.
18. Yuniadi Y, Ningrum NR. Risk factors and incidence of contrast induced nephropathy following coronary intervention. 2008;17(2):131â€“7.
19. Rundback JH, Nahl D, Yoo V. Contrast-induced nephropathy. J Vasc Surg [Internet]. 2011;54(2):575â€“9. Available from: http://dx.doi.org/10.1016/j.jvs.2011.04.047
20. Bainey KR, Rahim S, Etherington K, Rokoss ML, Natarajan MK, Velianou JL, et al. Effects of withdrawing vs continuing renin-angiotensin blockers on incidence of acute kidney injury in patients with renal insufficiency undergoing cardiac catheterization: Results from the Angiotensin Converting Enzyme Inhibitor/Angiotensin Receptor Bloc. Am Heart J [Internet]. 2015;170(1):110â€“6. Available from: http://dx.doi.org/10.1016/j.ahj.2015.04.019
21. Patel K, King CA, Jovin IS. Angiotensin-converting enzyme inhibitors and their effects on contrast-induced nephropathy after cardiac catheterization or percutaneous coronary intervention. Cardiovasc revascularization Med Incl Mol Interv [Internet]. 2011;12(2):90â€“3. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21421186
22. Chang CF, Lin CC. Current concepts of contrast-induced nephropathy: A brief review. J Chinese Med Assoc [Internet]. 2013;76(12):673â€“81. Available from: http://dx.doi.org/10.1016/j.jcma.2013.08.011
23. Lucreziotti S, Centola M, Salerno-Uriarte D, Ponticelli G, Battezzati PM, Castini D, et al. Female gender and contrast-induced nephropathy in primary percutaneous intervention for ST-segment elevation myocardial infarction. Int J Cardiol [Internet]. 2014;174(1):37â€“42. Available from: http://dx.doi.org/10.1016/j.ijcard.2014.03.087
24. Robert AM, Brown JR, Sidhu MS, Ramanath VS, DeVries JT, Jayne JE, et al. The evaluation of creatinine clearance, estimated glomerular filtration rate and serum creatinine in predicting contrast-induced acute kidney injury among patients undergoing percutaneous coronary intervention. Cardiovasc Revascularization Med [Internet]. 2012;13(1):3â€“10. Available from: http://dx.doi.org/10.1016/j.carrev.2011.05.006
25. Barbieri L, Verdoia M, Schaffer A, Marino P, De Luca G. Contrast Volume To Creatinine Clearance Ratio in the Prediction of Contrast Induced Neprophathy in Patients Undergoing Coronary Angiography or Percutaneous Intervention. J Am Coll Cardiol [Internet]. 2015;65(10):A1747. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0735109715617478
26. Chen J, Liu Y. Contrast Volume To Creatinine Clearance Ratio Predicts Outcomes After Percutaneous Coronary Intervention. J Am Coll Cardiol [Internet]. 2012;59(13):E513. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0735109712605142
27. New JP, Aung T, Baker PG, Yongsheng G, Pylypczuk R, Houghton J, et al. The high prevalence of unrecognized anaemia in patients with diabetes and chronic kidney disease: a population-based study. Diabet Med. 2008;25(5):564â€“9.
28. Murakami R, Kumita SI, Hayashi H, Sugizaki KI, Okazaki E, Kiriyama T, et al. Anemia and the risk of contrast-induced nephropathy in patients with renal insufficiency undergoing contrast-enhanced MDCT. Eur J Radiol [Internet]. 2013;82(10):e521â€“4. Available from: http://dx.doi.org/10.1016/j.ejrad.2013.06.004
29. Shacham Y, Gal-Oz A, Leshem-Rubinow E, Arbel Y, Flint N, Keren G, et al. Association of admission hemoglobin levels and acute kidney injury among myocardial infarction patients treated with primary percutaneous intervention. Can J Cardiol [Internet]. 2015;31(1):50â€“5. Available from: http://dx.doi.org/10.1016/j.cjca.2014.11.001
30. Mehta RL, Kellum JA, Shah S V., Molitoris BA, Ronco C, Warnock DG, et al. Acute kidney injury network: Report of an initiative to improve outcomes in acute kidney injury. Crit Care. 2007;11(2):1â€“8.
31. Tsai TT, Patel UD, Chang TI, Kennedy KF, Masoudi FA, Matheny ME, et al. Contemporary incidence, predictors, and outcomes of acute kidney injury in patients undergoing percutaneous coronary interventions: Insights from the NCDR cath-PCI registry. JACC Cardiovasc Interv. 2014;7(1):1â€“9.
32. James MT, Ghali WA, Knudtson ML, Ravani P, Tonelli M, Faris P, et al. Associations between acute kidney injury and cardiovascular and renal outcomes after coronary angiography. Circulation. 2011;123(4):409â€“16.
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