Review Article

ACE-I/ARB Therapy prior to Contrast Exposure: What Should the Clinician Do?

Table 1

Studies indicating harm or benefit of ACE-I or ARB in CIN.

Reference, yearStudy populationSample sizeStudy typeBrief descriptionKey findings and comments

Dangas et al., 2005 [7]CKD and non-CKD7,230 P.O1,980 pts with CKD and 5,250 without CKD used to determine predictors of CIN in PCITaking an ACE-I was associated with a lower risk of CIN in CKD pts

Toprak, 2006 [23] Near normal renal function80RCT42 pts received captopril while 32 controls received no captoprilCIN occurred 2.5x more in the captopril group

Dadpey et al., 2007 [29] Normal renal function undergoing PCI240RCT60 pts in each of four gps of ACI-I, diuretics, with a 36 hours discontinuation of these drugs as controlsNeither diuretic nor ACE-I discontinuation or continuation increased the risk of CIN

Spatz et al., 2012 [11] Stage III-IV CKD178RPts were either on ACE-I, ARB, or both RAAS blockade before PCI did not increase CIN risk

Bariş et al., 2013 [37]Near normal renal function295P.OPts in 3gps of ACE-I ( ) ARB ( ), and control group on no RAAS ( )Chronic usage of ACE-I and ARB increases the risk of CIN

Cirit et al., 2006 [25]>65 yrs with mild-moderate CKD230P.OOne gp on ACE-I for 2 months versus gp without ACE-I before PCIACE-I increased risk of CIN

Rosenstock et al., 2008 [28]Stage III-IV CKD 281RCT Pts on ACE-I/ARBs with therapy stopped 24 hrs before or continued compared to control before PCINo difference in postprocedure creatinine, eGFR, and incident CIN in the 3 groups

Hölscher et al., 2008 [24]Adults with creatinine of 1.5 to 3.5 mg/dL412Post hoc RCTACE-I administered to pts for elective PCI in the Dialysis-versus-Diuresis (DVD) trialACE-I therapy increased risk of CIN 6-fold

Umruddin et al., 2012 [26]Pts with multiple risk factors201R, case controlExposure to ACE-I/ARB was determined in the two gpsExposure to ACE-I or ARB doubled the risk of CIN

Rim et al., 2012 [27]Adults undergoing elective PCI.5,300RStudy compared 1322 users of ACE-I or ARBs and 1322 nonusers matched by propensity scoringCIN was higher in ACE-I/ARB than in nonusers (11.4% versus 6.3%; )

Gupta et al., 1999 [30] Adults with diabetes mellitus71RCTCaptopril administered 1 hr before angiography versus none for the control gpExposure to captopril reduced risk of CIN by 79%

Li et al., 2012 [31]Pts in RCTs involving ACE-Is792Meta-analysis of RCTSSearches in PubMed, MEDLINE, the Cochrane Central Register of Controlled Trials, and ISI Web of Science for impact of the ACE-Is on frequency of CIN[ACE-Is use protective] in pts with diabetes mellitus but showed no protection or harm in other pts

Abbreviations: ACE-I: angiotensin converting enzyme inhibitor; ARBs: angiotensin receptor blockers; CIN: contrast-induced nephropathy; CKD: chronic kidney disease; e-GFR: estimated glomerular filtration rate; Gp: group; PCI: percutaneous coronary intervention; Pts: patients; P.O: Prospective observational; RAAS: renin angiotensin aldosterone system; R: retrospective; RCT: randomized controlled trial.