Archive | 2019
The effect of ACEI/ARB on contrast induced nephrology: system review and meta-analysis
Abstract
Objective \nContrast-induced nephropathy (CIN) is the third leading cause of in-hospital acute renal failure. Angiotensin conversing enzyme inhibitor(ACEI)and angiotensinâ…ˇreceptor blocker(ARB) are commonly used to treat hypertension, heart falure and diabetic nephropathy. However, the role of ACEI and ARB in CIN is controversial. Our aim is to conduct a meta-analysis of these trials to assess the relationship between ACEI or ARB and CIN. \n \n \nMethods \nWe performed a literature search of PubMed, Cochrane library, Web of Science using the keywords about Renin Angiotensin System inhibitors, including the name of drugs, and contrast induced nephropathy. The primary end point is CIN. We carried out data on author, publishing year, patients characteristics, definition of CIN, complications(hypertension, diabetes, coronary heart diseases, et al), type and volume of contrast media, prevention strategies. All statistical analyses were performed using Review Manager version 5.3. \n \n \nResults \nA total of 14 trials were pooled. 5 868 patients received ACEI/ARB treatment and 3 081 patients were in the control group. The incidence of CIN was 12.5%(n=735) in ACEI/ARB group, 7.9%(n=244) in control group. The meta-analysis of 14 trials found ACEI or ARB can increase the risk of contrast-induced nephropathy (OR=1.56, 95% CI 1.06~2.31, P= 0.03). In the 6 randomized controlled trials, the incidence of CIN was 9.4%(n=38) in ACEI/ARB group, 10.7%(n=40) in control group. The meta-analysis of 6 randomized controlled trials showed that ACEI or ARB have no effect on CIN(OR=0.91, 95% CI 1.57~1.47, P=0.71). In the 6 observational studies, the incidence of CIN was 9.7% in ACEI/ARB group, 9% in control group. The meta-analysis of 6 observational studies showed that ACEI or ARB can increase the risk of CIN(OR= 2.76, 95% CI 1.82~4.17, P<0.00001). \n \n \nConclusions \nACEI/ARB can increase the risk of CIN. \n \n \nKey words: \nAngiotensin conversing enzyme inhibitor;\xa0Angiotensin â…ˇreceptor blocker;\xa0Contrast induced nephropathy;\xa0System review;\xa0Meta-analysis