Renal Safety and Renin–Angiotensin–Aldosterone System Inhibitors in Patients With Contrast Media Exposure: A Multicenter Randomized Controlled Study. Issue 5 (7th November 2022)

• Record Type: Journal Article
• Authors: Lin, Yaowang; Dong, Shaohong; Liu, Yuanhui; Wang, Yongshun; Sun, Xin; Yuan, Jie; Yu, Danqing; Liu, Huadong
• Is Part Of: Journal of cardiovascular pharmacology. Volume 80:Issue 5(2022)
• Page Start: 718
• Page End: 724
• Publication Date: 2022-11-07
• Subjects: angiotensin-converting enzyme inhibitors -- angiotensin receptor blockers -- renin–angiotensin–aldosterone system -- contrast-induced acute kidney injury; Cardiovascular Diseases -- drug therapy -- Periodicals; Cardiovascular System -- drug effects -- Periodicals; Cardiovascular pharmacology -- Periodicals; Cardiovascular agents -- Periodicals; Cardiovascular agents; Cardiovascular pharmacology; Periodicals; 615.7105
• DOI: 10.1097/FJC.0000000000001325
• Languages: English
• ISSNs: 0160-2446

Abstract

Abstract: There is no clear consensus on the safety of renin–angiotensin–aldosterone system inhibitors in patients with contrast media exposure. We aimed to assess the safety of renin–angiotensin–aldosterone system inhibitors in patients exposed to contrast media at 1-year follow-up. Patients treated with angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB) were recruited and randomly divided into 2 groups (1:1 ratio): with ACEI/ARB group (ACEI/ARB continued throughout the study period) and without ACEI/ARB group (ACEI/ARB stopped 24 hours before and continued 48 hours after the procedure). The primary endpoint was contrast-induced acute kidney injury (CI-AKI) and secondary endpoints were major adverse cardiovascular events (MACEs), and the need for renal replacement therapy during hospitalization and at 1-year follow-up. The occurrence rates of CI-AKI were not comparable in the ACEI/ARB group and the without ACEI/ARB group (2.92% and 2.62%, respectively; P = 0.866). No significant between-group differences were found with respect to the frequency of MACEs or renal replacement therapy during hospitalization and at 1-year follow-up. On subgroup analysis, among patients with estimated glomerular filtration rate (eGFR) < 45 mL/min, the incidence of CI-AKI was significantly higher in the ACEI/ARB group [17.95% (14/78) vs. 6.02% (5/83), P = 0.029]. Among patients with eGFR ≥ 45 mL/min, the incidence of CI-AKI was comparable in the 2 groups [0.87% (5/572) vs. 2.12% (12/567), P = 0.094]. The incidence of MACEs and renal replacement therapy was not comparable in the 2 groups, during hospitalization and at 1-year follow-up. ACEI or ARB treatment can safely be continued after exposure to contrast media, but not in patients with eGFR < 45 mL/min.