Is Administration of Preoperative Angiotensin-Converting Enzyme Inhibitors Important for Renal Protection after Cardiac Surgery?. (June 2013)

• Record Type: Journal Article
• Authors: Dag, Ozgur; Kaygin, Mehmet Ali; Aydin, Ahmet; Limandal, Husnu Kamil; Arslan, Ümit; Kiymaz, Adem; Kahraman, Nail; Calik, Eyup Serhat; Erkut, Bilgehan
• Is Part Of: Renal failure. Volume 35:Number 5(2013)
• Page Start: 754
• Page End: 760
• Publication Date: 2013-06
• Subjects: Chronic renal failure -- Periodicals; Acute renal failure -- Periodicals; Uremia -- Periodicals; 616.614005
• DOI: 10.3109/0886022X.2013.777891
• Languages: English
• ISSNs: 0886-022X

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <p> <italic>Objective</italic>: There are various reasons for renal dysfunction after cardiac surgery; however, activation of the renin–angiotensin system has an important role following cardiac surgery. We investigated the effect of preoperative angiotensin-converting enzyme (ACE) inhibitors on renal functions after cardiovascular surgery. <italic>Material–methods</italic>: Three hundred sixty-six patients awaiting elective cardiac surgery were allocated to two groups, namely the treatment group, comprising the ACE inhibitor group (<italic>n</italic> = 186), and the control group, which was without ACE inhibitor (<italic>n</italic> = 180). The renal parameters [blood urea nitrogen, creatinine, creatinine clearance, and glomerular filtration rate (GFR)] and the need for dialysis were evaluated associated with renal functions between the two groups in the postoperative period. <italic>Results</italic>: After cardiac surgery, renal dysfunction requiring dialysis developed in 11 (3.8%) patients in the control group patients. There was no required dialysis in the treatment group (<italic>p <</italic> 0.05). As an indicator of renal dysfunction, the increase in creatinine and blood urea nitrogen levels and the decrease in GFR and creatinine clearance were higher in the control group (<italic>p</italic> < 0.05). The multivariate analysis indicated that therapy with ACE inhibitors was found to decrease the incidence of postoperative renal dysfunction (odds ratio, 1.07; 95% confidence interval, 0.45–2.50; <italic>p <</italic> 0.05). The other independent predictors were age, preoperative intra-aortic blood pump, hypertension, diabetes mellitus, and a left ventricular ejection fraction below 0.40. <italic>Conclusion</italic>: Preoperative therapy with ACE inhibitors has an influence on renal functions. This study demonstrates that administration of ACE inhibitors provides better renal protection after cardiac surgery.</p> </abstract>