scholarly journals ACE-I/ARB Therapy prior to Contrast Exposure: What Should the Clinician Do?

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Robert Kalyesubula ◽  
Peace Bagasha ◽  
Mark A. Perazella
Keyword(s):  
Contrast Media ◽  
Angiotensin Receptor Blockers ◽  
Kidney Injury ◽  
Current Evidence ◽  
Contrast Induced Nephropathy ◽  
Contrast Exposure ◽  
Receptor Blockers ◽  
Stage Renal Disease ◽  
End Stage ◽  
Prolonged Hospital

Contrast-induced nephropathy (CIN) is now one of the three leading causes of acute kidney injury in the world. A lot is known about the risk factors of CIN, yet it remains a major cause of morbidity, end stage renal disease, prolonged hospital stay, and increased costs as well as a high mortality. Many patients undergoing contrast-based radiological investigations are treated with angiotensin converting inhibitors (ACE-Is) or angiotensin receptor blockers (ARBs) for their cardiac and renal benefits and their known mortality benefits. However, controversy exists among clinicians as to whether ACE-Is and ARBs should be continued or discontinued prior to contrast media exposure. In this paper we review the current evidence on ACE-I/ARB therapy for patients undergoing procedures involving use of contrast media and provide recommendations as to whether these drugs should be continued or held prior to contrast exposure.

scholarly journals Contrast-induced nephropathy and oxidative stress: mechanistic insights for better interventional approaches

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Prit Kusirisin ◽  
Siriporn C. Chattipakorn ◽  
Nipon Chattipakorn
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Contrast Media ◽  
Impaired Renal Function ◽  
Kidney Injury ◽  
Diagnostic Procedures ◽  
Volume Depletion ◽  
Contrast Induced Nephropathy ◽  
Stage Renal Disease ◽  
End Stage

Abstract Contrast-induced nephropathy (CIN) or contrast-induced acute kidney injury (CI-AKI) is an iatrogenic acute kidney injury observed after intravascular administration of contrast media for intravascular diagnostic procedures or therapeutic angiographic intervention. High risk patients including those with chronic kidney disease (CKD), diabetes mellitus with impaired renal function, congestive heart failure, intraarterial intervention, higher volume of contrast, volume depletion, old age, multiple myeloma, hypertension, and hyperuricemia had increased prevalence of CIN. Although CIN is reversible by itself, some patients suffer this condition without renal recovery leading to CKD or even end-stage renal disease which required long term renal replacement therapy. In addition, both CIN and CKD have been associated with increasing of mortality. Three pathophysiological mechanisms have been proposed including direct tubular toxicity, intrarenal vasoconstriction, and excessive production of reactive oxygen species (ROS), all of which lead to impaired renal function. Reports from basic and clinical studies showing potential preventive strategies for CIN pathophysiology including low- or iso-osmolar contrast media are summarized and discussed. In addition, reports on pharmacological interventions to reduce ROS and attenuate CIN are summarized, highlighting potential for use in clinical practice. Understanding this contributory mechanism could pave ways to improve therapeutic strategies in combating CIN.

scholarly journals Outcomes of Chronic Hemodialysis Patients in the Intensive Care Unit

2013 ◽  
Vol 2013 ◽  
pp. 1-7
Author(s):  
Melanie Chan ◽  
Marlies Ostermann
Keyword(s):  
Intensive Care Unit ◽  
Renal Function ◽  
Intensive Care ◽  
Kidney Injury ◽  
Chronic Hemodialysis ◽  
Current Evidence ◽  
Icu Outcome ◽  
Stage Renal Disease ◽  
End Stage

Patients with end-stage renal disease (ESRD) experience higher rates of hospitalisation, cardiovascular events, and all-cause mortality and are more likely to require admission to the intensive care unit (ICU) than patients with normal renal function. Sepsis and cardiovascular diseases are the most common reasons for ICU admission. ICU mortality rates in patients requiring chronic hemodialysis are significantly higher than for patients without ESRD; however, dialysis patients have a better ICU outcome than those with acute kidney injury (AKI) requiring renal replacement therapy suggesting that factors other than loss of renal function contribute to their prognosis. Current evidence suggests, the longer-term outcomes after discharge from ICU may be favourable and that long-term dependence on dialysis should not prejudice against prompt referral or admission to ICU.

scholarly journals Angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, β-blockers or both in incident end-stage renal disease patients without cardiovascular disease: a propensity-matched longitudinal cohort study

2018 ◽  
Vol 34 (7) ◽  
pp. 1216-1222 ◽  
Author(s):  
João Pedro Ferreira ◽  
Cécile Couchoud ◽  
John Gregson ◽  
Aurélien Tiple ◽  
François Glowacki ◽  
...  
Keyword(s):  
Enzyme Inhibitors ◽  
Angiotensin Receptor Blockers ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Converting Enzyme Inhibitors ◽  
Receptor Blockers ◽  
Β Blockers ◽  
Cv Disease ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Abstract Background End-stage renal disease (ESRD) patients even without known cardiovascular (CV) disease have high mortality rates. Whether neurohormonal blockade treatments improve outcomes in this population remains unknown. The aim of this study was to assess the effect of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEi/ARBs), β-blockers or both in all-cause mortality rates in incident ESRD patients without known CV disease starting renal replacement therapy (RRT) between 2009 and 2015 in the nationwide Réseau Epidémiologie et Information en Néphrologie registry. Methods Patients with known CV disease and those who started emergency RRT, stopped RRT or died within 6 months were excluded. Propensity score matching models were used. The main outcome was all-cause mortality. Results A total of 13 741 patients were included in this analysis. The median follow-up time was 24 months. When compared with matched controls without antihypertensive treatment, treatment with ACEi/ARBs, β-blockers and ACEi/ARBs + β-blockers was associated with an event-rate reduction per 100 person-years: ACEi/ARBs 7.6 [95% confidence interval (CI) 7.1–8.2] versus matched controls 9.5 (8.8–10.1) [HR 0.76 (95% CI 0.69–0.84)], β-blocker 7.1 (6.6–7.7) versus matched controls 9.5 (8.5–10.2) [HR 0.72 (0.65–0.80)] and ACEi/ARBs + β-blockers 5.8 (5.4–6.4) versus matched controls 7.8 (7.2–8.4) [HR 0.68 (0.61–0.77)]. Conclusions Neurohormonal blocking therapies were associated with death rate reduction in incident ESRD without CV disease. Whether these relationships are causal will require randomized controlled trials.

Angiotensin-converting enzyme inhibitors versus angiotensin receptor blockers for end-stage renal disease/mortality in type 2 diabetes

2013 ◽  
Vol 102 (3) ◽  
pp. 233-241 ◽  
Author(s):  
Heather M. Campbell ◽  
Nasreen Khan ◽  
Dennis W. Raisch ◽  
Matthew E. Borrego ◽  
Mike R. Sather ◽  
...  
Keyword(s):  
Enzyme Inhibitors ◽  
Angiotensin Receptor Blockers ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Angiotensin Receptor ◽  
Converting Enzyme Inhibitors ◽  
Disease Mortality ◽  
Receptor Blockers ◽  
Stage Renal Disease ◽  
End Stage

Abstract 12830: Primary Prevention of Atrial Fibrillation With Angiontensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers in Patients of End-Stage Renal Disease- A Nationwide Cohort Study Using Insurance Claims Database

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Ting-Tse Lin ◽  
Min-Tsun Liao ◽  
Lian-Yu Lin
Keyword(s):  
Primary Prevention ◽  
End Stage Renal Disease ◽  
Enzyme Inhibitors ◽  
Angiotensin Receptor Blockers ◽  
Converting Enzyme ◽  
Angiotensin Receptor ◽  
Converting Enzyme Inhibitors ◽  
Receptor Blockers ◽  
Stage Renal Disease ◽  
End Stage

Background: Current evidence suggests that angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARB) reduce the incidence of new atrial fibrillation (AF) in a variety of settings including the treatment of left ventricular dysfunction or hypertension. This study was to assess whether ACEIs and ARB could decrease incidence of AF in patients of end stage renal disease (ESRD). Materials and Methods: We identified all patients who developed ESRD through January 1998 to December 2008 from the National Health Insurance Research Database, Taiwan. The primary endpoint was new onset of AF and the median duration of follow up was 1499 days. The control group was patients not prescribing ACEIs or ARB. Hazard ration of both ACEIs vs. control and ARB vs. control were analyzed. Results: Among 102688 patients, 14926 (14.5%) were prescribed with ACEIs, 16282 (15.9) with ARB but 71480 (69.6%) were not prescribed ACEIs or ARB. Overall, patients treated with ACEIs (adjusted hazard ratio [HR] 0.587, 95% confidence interval [CI] 0.519-0.633, P<0.001 ) or ARB (adjusted HR 0.542, 95% CI 0.461-0.637, P<0.001 ) had a reduced incidence of AF. The preventive effect between two classes of drugs was favored ARB (P<0.001). The longer patients taking ACEIs or ARB, the better prevention of AF are. The similar reduction of AF is also noted in stratified analysis of age, gender, hypertension, congestive heart failure and diabetes. Conclusion: Both ACEIs and ARB appear to be effective in the primary prevention of AF in ESRD patients. This analysis supports the concept of renin-angiotensin system inhibition as an emerging treatment for the primary prevention of AF.

Diabetic Nephropathy

2011 ◽  
Vol 4 (12) ◽  
pp. 706-711 ◽  
Author(s):  
Rafay Iqbal ◽  
Shahzad Hussain Shah
Keyword(s):  
Diabetic Nephropathy ◽  
Enzyme Inhibitors ◽  
Angiotensin Receptor Blockers ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Converting Enzyme Inhibitors ◽  
Multiple Risk Factors ◽  
History Of ◽  
Receptor Blockers ◽  
Stage Renal Disease ◽  
End Stage

Diabetic nephropathy is the leading cause of renal failure in UK, accounting for 24% of patients with end-stage renal disease (ESRD). In addition, it is a risk factor for cardiovascular disease. Clinical trials have shown that it is possible to alter the natural history of diabetic nephropathy by targeting multiple risk factors. In clinical practice, this includes tight glycaemic control, aggressive antihypertensive therapy and the use of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs). This article aims to describe management of diabetic nephropathy in primary care and provide guidance on when to refer to secondary care.

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