NDT Advance Access published online on November 9, 2009
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfp582
Impact of renin-angiotensin-aldosterone blockade by angiotensin-converting enzyme inhibitors or AT-1 blockers on frequency of contrast medium-induced nephropathy: a post-hoc analysis from the Dialysis-versus-Diuresis (DVD) trial
1 Department of Pediatric Cardiology 2 Department of Cardiology and Angiology 3 Department of Internal Medicine B—Nephrology and Hypertension, University Hospital of Muenster, Muenster, Germany
Correspondence and offprint requests to: Daniela Kiski; E-mail: Daniela.Kiski{at}ukmuenster.de
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Abstract |
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Background. After exposure to contrast medium (CM), about 10% of patients will develop contrast medium-induced nephropathy (CIN), with severe consequences for their prognosis. Although numerous studies evaluated risk factors for CIN development, it is still a matter of debate whether treatment with angiotensin-converting enzyme inhibitors (ACE-I) or AT-1 blockers increases the frequency of CIN after exposure to CM or not.
Methods. We performed a prospective, single-centre study (January 2001–July 2004) to compare different treatments for CIN prevention. Creatinine levels within 72 h after CM application and in-hospital outcomes were documented. The impact of RAAS blockade on the frequency of CIN was assessed retrospectively.
Results. Four hundred twelve patients were included (83.5% men, 29.1% diabetes mellitus, 74.6% hypertension). Of these, 269 patients (65.3%) were taking ACE-I (n = 236) or AT-1 blockers (n = 33). There were no significant differences in mean age (P = 0.075), creatinine levels (P = 0.113), gender (P = 0.281), diabetes mellitus (P = 0.172) or left ventricular ejection fraction (P = 0.09) between patients treated or not treated with RAAS blockade. Univariate analyses concerning development of CIN depending on treatment with RAAS blockade within 72 h found CIN to be significantly higher in patients treated with RAAS blockade (11.9 vs 4.2%, P = 0.006). Multivariate analyses (logistic regression) identified RAAS blockade to be an independent predictor of CIN (odds ratio 3.082, 95% confidence interval 1.234–7.698, P = 0.016).
Conclusion. Patients treated with RAAS blockade before exposure to CM develop significantly more often CIN within 72 h. Even after adjustment for confounding comorbidities, treatment with ACE-I or AT-1 blockers turned out to be an independent risk predictor.
Keywords: contrast medium-induced nephropathy; RAAS blockade
Received for publication: 18. 2.09
Accepted in revised form: 12.10.09