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

The Korean Journal of Internal Medicine 2014년 29권 2호 p.203 ~ p.209

(Goo Ja-Jun) - Maryknoll Medical Center Department of Internal Medicine
김재준(Kim Jae-Joon) - Maryknoll Medical Center Department of Internal Medicine
강지훈(Kang Ji-Hoon) - Maryknoll Medical Center Department of Internal Medicine
(Kim Kyoung-Nyoun) - Maryknoll Medical Center Department of Internal Medicine
변기섭(Byun Ki-Sup) - Maryknoll Medical Center Department of Internal Medicine
김미경(Kim Mi-Kyung) - Maryknoll Medical Center Department of Internal Medicine
김태익(Kim Tae-Ik) - Maryknoll Medical Center Department of Internal Medicine

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.