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Does renin-angiotensin aldosterone system blockade exacerbate contrast-induced nephropathy in patients with chronic kidney disease? A prospective 50-month Mayo Clinic study.
Ren Fail. 2008; 30(1):67-72.RF

Abstract

Contrast induced nephropathy, a leading cause of new-onset renal failure in U.S. hospitals, may be accelerated by concurrent RAAS blockade in CKD patients. Current literature is inconclusive. Between September 2002 and February 2005, we prospectively enrolled all CKD patients on RAAS blockade who developed contrast-induced nephropathy. RAAS blockade was discontinued, standard nephrology care applied, and eGFR by MDRD was monitored. Seven patients (M:F, 3:4; age, 72.3 years) were enrolled. Mean duration of RAAS blockade at enrollment was 25.8 months. Baseline vs. enrollment eGFR was 45.5 +/- 17 vs. 16.6 +/- 6.8 mL/min/1.73 m(2), p = 0.009. Three of the seven patients (43%) required dialysis, one temporarily. Two older patients (mean age, 81.5 vs. 68.6 years, p = 0.017) progressed to ESRD. eGFR in five non-ESRD patients increased from 18.5 +/- 7.1 to 41.0 +/- 27.1 mL/min/1.73 m(2) after 29.4 months. Baseline eGFR was lower in the two patients who developed ESRD (29.5 vs. 51.2 mL/min/1.73 m(2)). Two patients exhibited very steep serum creatinine trajectories, indicative of rapid loss of eGFR. New onset proteinuria was observed. We have demonstrated very bad renal outcomes with three of seven (43%) patients requiring dialysis, with two (29%) progressing to ESRD. In two patients, loss of eGFR was clearly accelerated. These findings support the view that concurrent RAAS blockade, particularly in older CKD patients, exacerbates contrast-induced nephropathy. Also, lower baseline eGFR predicted worse renal outcomes. We support the recommendation to withhold RAAS blockade, 48 hours before contrast exposure, to improve renal outcomes.

Authors+Show Affiliations

Mayo Clinic College of Medicine, Rochester, Minnesota, USA. onuigbo@macaulay@mayo.eduNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18197546

Citation

Onuigbo, Macaulay A C., and Nnonyelum T C. Onuigbo. "Does Renin-angiotensin Aldosterone System Blockade Exacerbate Contrast-induced Nephropathy in Patients With Chronic Kidney Disease? a Prospective 50-month Mayo Clinic Study." Renal Failure, vol. 30, no. 1, 2008, pp. 67-72.
Onuigbo MA, Onuigbo NT. Does renin-angiotensin aldosterone system blockade exacerbate contrast-induced nephropathy in patients with chronic kidney disease? A prospective 50-month Mayo Clinic study. Ren Fail. 2008;30(1):67-72.
Onuigbo, M. A., & Onuigbo, N. T. (2008). Does renin-angiotensin aldosterone system blockade exacerbate contrast-induced nephropathy in patients with chronic kidney disease? A prospective 50-month Mayo Clinic study. Renal Failure, 30(1), 67-72. https://doi.org/10.1080/08860220701742153
Onuigbo MA, Onuigbo NT. Does Renin-angiotensin Aldosterone System Blockade Exacerbate Contrast-induced Nephropathy in Patients With Chronic Kidney Disease? a Prospective 50-month Mayo Clinic Study. Ren Fail. 2008;30(1):67-72. PubMed PMID: 18197546.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Does renin-angiotensin aldosterone system blockade exacerbate contrast-induced nephropathy in patients with chronic kidney disease? A prospective 50-month Mayo Clinic study. AU - Onuigbo,Macaulay A C, AU - Onuigbo,Nnonyelum T C, PY - 2008/1/17/pubmed PY - 2008/5/3/medline PY - 2008/1/17/entrez SP - 67 EP - 72 JF - Renal failure JO - Ren Fail VL - 30 IS - 1 N2 - Contrast induced nephropathy, a leading cause of new-onset renal failure in U.S. hospitals, may be accelerated by concurrent RAAS blockade in CKD patients. Current literature is inconclusive. Between September 2002 and February 2005, we prospectively enrolled all CKD patients on RAAS blockade who developed contrast-induced nephropathy. RAAS blockade was discontinued, standard nephrology care applied, and eGFR by MDRD was monitored. Seven patients (M:F, 3:4; age, 72.3 years) were enrolled. Mean duration of RAAS blockade at enrollment was 25.8 months. Baseline vs. enrollment eGFR was 45.5 +/- 17 vs. 16.6 +/- 6.8 mL/min/1.73 m(2), p = 0.009. Three of the seven patients (43%) required dialysis, one temporarily. Two older patients (mean age, 81.5 vs. 68.6 years, p = 0.017) progressed to ESRD. eGFR in five non-ESRD patients increased from 18.5 +/- 7.1 to 41.0 +/- 27.1 mL/min/1.73 m(2) after 29.4 months. Baseline eGFR was lower in the two patients who developed ESRD (29.5 vs. 51.2 mL/min/1.73 m(2)). Two patients exhibited very steep serum creatinine trajectories, indicative of rapid loss of eGFR. New onset proteinuria was observed. We have demonstrated very bad renal outcomes with three of seven (43%) patients requiring dialysis, with two (29%) progressing to ESRD. In two patients, loss of eGFR was clearly accelerated. These findings support the view that concurrent RAAS blockade, particularly in older CKD patients, exacerbates contrast-induced nephropathy. Also, lower baseline eGFR predicted worse renal outcomes. We support the recommendation to withhold RAAS blockade, 48 hours before contrast exposure, to improve renal outcomes. SN - 0886-022X UR - https://www.unboundmedicine.com/medline/citation/18197546/Does_renin_angiotensin_aldosterone_system_blockade_exacerbate_contrast_induced_nephropathy_in_patients_with_chronic_kidney_disease_A_prospective_50_month_Mayo_Clinic_study_ DB - PRIME DP - Unbound Medicine ER -