Abstract
Objective:This study evaluated the potential effect of hydration intensity on the role of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) on contrast-induced nephropathy in patients with renal insufficiency.Methods:All eligible patients were included and stratified according to hydration intensity defined as saline hydration volume to body weight tertiles: <10.21 mL/kg, 10.21 to <17.86 mL/kg, and ⩾17.86 mL/kg.Results:In total, 84 (6.7%) of 1254 patients developed contrast-induced nephropathy: 6.2% in the ACEI/ARB group versus 10.8% in the non-ACEI/ARB group (P=0.029), with an adjusted odds ratio (OR) of 0.89 (95% confidence interval (CI) 0.46–1.73, P=0.735). The incidence of contrast-induced nephropathy was lower in the ACEI/ARB group than in the non-ACEI/ARB group in the second tertile (P=0.031), while not significantly different in the first (P=0.701) and third (P=0.254) tertiles. ACEIs/ARBs were independently associated with a lower contrast-induced nephropathy risk (OR 0.26, 95% CI 0.09–0.74, P=0.012) and long-term all-cause death (hazard ratio 0.461, 95% CI 0.282–0.755, P=0.002) only in the second hydration volume to body weight tertile.Conclusion:The effects of ACEIs/ARBs on contrast-induced nephropathy risk vary according to saline hydration intensity in chronic kidney disease patients, and may further reduce contrast-induced nephropathy risk in patients administered moderate saline hydration.
Highlights
The incidences of Contrast-induced nephropathy (CIN) were significantly lower in patients treated with periprocedural angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs) than non-users (6.2% vs. 10.8%, P=0.029)
Consistent with the results mentioned above, multivariate logistic regression analysis revealed that the periprocedural administration of ACEIs/ARBs significantly reduced the risk of CIN after coronary catheterisation in chronic kidney disease (CKD) patients only in the second tertile after adjusting for age greater than 75 years, creatinine clearance rate (CrCl) less than 30 mL/minute, chronic heart failure (CHF), contrast volume, anaemia, systolic blood pressure (SBP), DBP and hydration volume-to-weight (HV/W) ratio
The key finding of our study was that the effect of ACEIs/ ARBs on CIN in CKD patients varied according to the intensity of hydration
Summary
Contrast-induced nephropathy (CIN) is a common complication after coronary catheterization, with an incidence of as high as 20–40% in patients with renal insufficiency, and is associated with increased in-hospital and long-term clinical outcome, as well as prolonged hospital stay and raised healthcare costs.[1,2,3] Avoiding the use of nephrotoxic drugs is one of the most fundamental preventive strategies for CIN. It is a common practice in many centres to prescribe angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) for patients with coronary artery disease before and after coronary. We hypothesised that saline hydration may further influence the circulatory volume and the renal blood flow after the administration of ACEIs/ARBs, affecting the development of CIN
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