Impact of Angiotensin-Converting Enzyme Inhibitors/Angiotensin Receptor Blockers on Renal Function in Chronic Kidney Disease Patients Undergoing Coronary Angiography

BACKGROUND Cardiac catheterizations and coronary angiography are minimally invasive methods for studying the heart and the coronary arteries, using iodinated radiocontrast agents which can cause acute kidney injury (AKI). Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARB) are widely used due to their well-established benefit in coronary artery disease and renal protection in diabetes mellitus. Renin-angiotensin-aldosterone system inhibitors can induce AKI in some patients. METHOD This study analyzed the effect of radiocontrast media used for coronary angiography on renal function in patients with chronic kidney disease (CKD) stages 2-5 who also took ACE inhibitors/ARB medications. Information was collected from the electronic medical records of 116 cases to determine changes in serum creatinine following angiography.  Result: The average age of patients was 65.2 ± 12.3 years. There were 89 men (76.7%) and 27 women (23.3%). Six patients had documented ACE inhibitor discontinuation, and one patient had documented ARB discontinuation prior to their procedures. Based on the criteria of an increase in serum creatinine (SCr) by ≥0.3 mg/dl within 48 hours, 19 cases (16.4%) had AKI. Based on the criteria of increasing in SCr to ≥ 1.5 times baseline, AKI developed in 2 cases (1.7%) on day 1, 4 cases (3.5%) on day 2, and 7 cases (6.0%) on day 3 after coronary angiography. CONCLUSION This study suggests that the continuation of ACE inhibitors/ARB does not appear to have any important effect or association with changes in renal function, within one-month post angiography in patients with CKD stages 2-5.