Korean J Intern Med.  2014 Mar;29(2):203-209. 10.3904/kjim.2014.29.2.203.

Effect of renin-angiotensin-system blockers on contrast-medium-induced acute kidney injury after coronary angiography

• Goo JJ
• Kim JJ
• Kang JH
• Kim KN
• Byun KS
• Kim MK
• Kim TI

• KMID: 1792036
• DOI: http://doi.org/10.3904/kjim.2014.29.2.203

Abstract

BACKGROUND/AIMS
With the increasing incidence of cardiovascular disease, angiocardiography using contrast-enhancing media has become an essential diagnostic and therapeutic tool, despite the risk of contrast-medium-induced acute kidney injury (CIAKI). CIAKI may be exacerbated by renin-angiotensin-system (RAS) blockers, which are also used in a variety of cardiovascular disorders. This study evaluated the effects of RAS blockade on CIAKI after coronary angiography.
METHODS
Patients who underwent coronary angiography in our hospital between May 2009 and July 2011 were reviewed. Serum creatinine levels before and after coronary angiography were recorded. CIAKI was diagnosed according to an increase in serum creatinine > 0.5 mg/dL or 25% above baseline.
RESULTS
A total of 1,472 subjects were included in this study. Patients taking RAS blockers were older, had a higher baseline creatinine level, lower estimated glomerular filtration rate (eGFR), and had received a greater volume of contrast medium. After propensity score matching, no difference was observed between the RAS (+) and RAS (.) groups. Multiple logistic regression identified RAS blockade, age, severe heart failure, contrast volume used, hemoglobin level, and eGFR as predictors of CIAKI. Multiple logistic regression after propensity matching showed that RAS blockade was associated with CIAKI (odds ratio, 1.552; p = 0.026).
CONCLUSIONS
This study showed that the incidence of CIAKI was increased in patients treated with RAS blockers.

Keyword

Renin angiotensin system; Coronary angiography; Acute kidney injury

MeSH Terms

Acute Kidney Injury/*chemically induced/diagnosis/epidemiology/physiopathology
Aged
Angiotensin II Type 1 Receptor Blockers/*adverse effects
Angiotensin-Converting Enzyme Inhibitors/*adverse effects
Biological Markers/blood
Chi-Square Distribution
Contrast Media/*adverse effects/diagnostic use
Coronary Angiography/*adverse effects
Creatinine/blood
Female
Glomerular Filtration Rate/drug effects
Humans
Incidence
Kidney/*drug effects/physiopathology
Logistic Models
Male
Middle Aged
Multivariate Analysis
Odds Ratio
Propensity Score
Renin-Angiotensin System/*drug effects
Republic of Korea/epidemiology
Retrospective Studies
Risk Assessment
Risk Factors
Angiotensin II Type 1 Receptor Blockers
Angiotensin-Converting Enzyme Inhibitors
Biological Markers
Contrast Media
Creatinine