The effects of chronic usage of angiotensin-converting enzyme inhibitors and angiotensin recep-tor blockers on contrast-induced nephropathy in low-risk patients

AKDENİZ, Bahri; DOĞAN BİLGİN, Nazile; KANGÜL, Hande; GÜL, Sefa; Baris, Nezihi; Güneri, Sema; Ozpelit, Ebru

The effects of chronic usage of angiotensin-converting enzyme inhibitors and angiotensin recep-tor blockers on contrast-induced nephropathy in low-risk patients

Nezihi BARIŞ, (Dokuz Eylül Üniversitesi, Tıp Fakültesi, Kardiyoloji Bölümü, İzmir, Türkiye)

Ebru ÖZPELİT, (Dokuz Eylül Üniversitesi, Tıp Fakültesi, Kardiyoloji Bölümü, İzmir, Türkiye)

Nazile DOĞAN BİLGİN, (Dokuz Eylül Üniversitesi, Tıp Fakültesi, Kardiyoloji Bölümü, İzmir, Türkiye)

Hande KANGÜL, (Dokuz Eylül Üniversitesi, Tıp Fakültesi, Kardiyoloji Bölümü, İzmir, Türkiye)

Sefa GÜL, (Dokuz Eylül Üniversitesi, Tıp Fakültesi, Kardiyoloji Bölümü, İzmir, Türkiye)

Bahri AKDENİZ, (Dokuz Eylül Üniversitesi, Tıp Fakültesi, Kardiyoloji Bölümü, İzmir, Türkiye)

Sema GÜNERİ (Dokuz Eylül Üniversitesi, Tıp Fakültesi, Kardiyoloji Bölümü, İzmir, Türkiye)

Anadolu Kardiyoloji Dergisi

3 2

Yıl: 2013 Cilt: 13 Sayı: 3 Sayfa Aralığı: 245 - 250 Metin Dili: Türkçe İndeks Tarihi: 29-07-2022

The effects of chronic usage of angiotensin-converting enzyme inhibitors and angiotensin recep-tor blockers on contrast-induced nephropathy in low-risk patients

Öz:

Amaç: Kontrast madde nefropatisi (KMN) koroner girişim yapılan hastalarda önemli bir sorundur. Renin- anjiyotensin-aldosteron sistemi (RAAS) bloker- lerinin KMN gelişimindeki rolüne ait veriler çelişkilidir. Bu çalışmada düşük riskli hastalarda kronik RAAS blokeri ilaç kullanımının KMN gelişimi üzerine olan etkisinin araştırılması amaçlanmıştır. Yöntemler: Prospektif kohort olarak dizayn edilen çalışmaya elektif koroner girişim yapılan 295 hasta alındı. RAAS blokeri kullanımına göre hastalar 3 ayrı gruptan oluşturuldu: RAAS blokeri kullanmayanlar (n=95), anjiyotensin dönüştürücü enzim inhibitörü (ADEİ) kullananlar (n=106), anjiyotensin reseptör blokeri (ARB) kullananlar (n=94). KMN koroner girişim sonrası 48-72 saat içinde bazal kreatinin değerinde %25 ve üzeri veya 0.5 mg/dL artış olması şek- linde tanımlandı. Her hasta için Mehran skoru hesaplandı. Gruplar arasındaki bazal veriler ve KMN gelişimi ANOVA, Mann-Whitney U, Kruskal-Wallis ve Pearson Ki-kare testleri ile karşılaştırıldı. KMN için bağımsız öngördürücülerin bulunabilmesi için binary lojistik regresyon analizi yapıldı. Bulgular: ADEİ grubunda 18 (%17.0), ARB grubunda 17 (%18.1), RAAS blokeri kullanmayan grupta 7 (%7.4) hastada KMN gelişti. RAAS blokeri alan grupta KMN gelişimi almayan gruba göre anlamlı olarak fazlaydı (sırasıyla %17.5 - %7.4, p=0.01). Kronik RAAS blokeri kullanımı (OR=2.69; %95 GA: 1.025-7.067; p=0.04) ve Mehran skoru (OR=1.15; %95 GA: 1.019-1.310; p=0.02) KMN için bağımsız öngördürücüler olarak bulundu. Sonuç: Elektif koroner girişim yapılan, normal veya normale yakın böbrek fonksiyonları olan hastalarda kronik ADEİ ve ARB kullanımı KMN gelişimi riski- ni arttırmaktadır.

Anahtar Kelime:

Konular: Kalp ve Kalp Damar Sistemi

Düşük riskli hastalarda anjiyotensin dönüştürücü enzim inhibitörleri ve anjiyotensin reseptör blokerlerinin kronik kullanımının kontrast madde nefropatisi üzerine etkileri

Öz:

Objective: There is conflicting data about the role of renin- angiotensin- aldosterone system (RAAS) blockers in contrast-induced nephropathy (CIN) pathophysiology. In this study, we aimed to investigate the effects of chronic usage of RAAS blocker drugs on development of CIN in low risk patients. Methods: Study was designed as a prospective cohort study. A total of 295 patients were enrolled in the study. Study population was consisted of three subgroups according to prior usage of RAAS blockers: no RAAS blocker group (n=95), angiotensin-converting enzyme inhibitor (ACEI) group (n=106), angiotensin receptor blocker (ARB) group (n=94). CIN was defined as an increase of ≥25% in creatinine over the baseline value or 0.5 mg/dL rise within 48-72 h of angiography. Mehran score was calculated for each patient. Baseline variables and percentage of CIN were compared with ANOVA, Mann-Whitney U, Kruskal-Wallis and Pearson Chi-square tests between groups. In order to determine the independent predictors of CIN, binary logistic regression analyses were performed. Results: CIN occurred in 18 patients (17.0%) in the ACEI group, 17 patients (18.1%) in ARB group and 7 patients (7.4%) in the no RAAS group. CIN occurrence was significantly higher in RAAS than no RAAS group (17.5% vs. 7.4%, p=0.01). Chronic RAAS blocker administration was an inde- pendent predictor of CIN (OR=2.69; 95% CI: 1.025-7.067; p=0.04). Mehran score was the only other independent predictor for CIN (OR=1.15; 95% CI: 1.019-1.310; p=0.02). Conclusion: In patients with near normal renal functions who are undergoing elective coronary procedure, chronic usage of ACEI and ARB increases the risk of CIN.

Anahtar Kelime:

Konular: Kalp ve Kalp Damar Sistemi

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

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APA	Baris N, Ozpelit E, DOĞAN BİLGİN N, KANGÜL H, GÜL S, AKDENİZ B, Güneri S (2013). The effects of chronic usage of angiotensin-converting enzyme inhibitors and angiotensin recep-tor blockers on contrast-induced nephropathy in low-risk patients. , 245 - 250.
Chicago	Baris Nezihi,Ozpelit Ebru,DOĞAN BİLGİN Nazile,KANGÜL Hande,GÜL Sefa,AKDENİZ Bahri,Güneri Sema The effects of chronic usage of angiotensin-converting enzyme inhibitors and angiotensin recep-tor blockers on contrast-induced nephropathy in low-risk patients. (2013): 245 - 250.
MLA	Baris Nezihi,Ozpelit Ebru,DOĞAN BİLGİN Nazile,KANGÜL Hande,GÜL Sefa,AKDENİZ Bahri,Güneri Sema The effects of chronic usage of angiotensin-converting enzyme inhibitors and angiotensin recep-tor blockers on contrast-induced nephropathy in low-risk patients. , 2013, ss.245 - 250.
AMA	Baris N,Ozpelit E,DOĞAN BİLGİN N,KANGÜL H,GÜL S,AKDENİZ B,Güneri S The effects of chronic usage of angiotensin-converting enzyme inhibitors and angiotensin recep-tor blockers on contrast-induced nephropathy in low-risk patients. . 2013; 245 - 250.
Vancouver	Baris N,Ozpelit E,DOĞAN BİLGİN N,KANGÜL H,GÜL S,AKDENİZ B,Güneri S The effects of chronic usage of angiotensin-converting enzyme inhibitors and angiotensin recep-tor blockers on contrast-induced nephropathy in low-risk patients. . 2013; 245 - 250.
IEEE	Baris N,Ozpelit E,DOĞAN BİLGİN N,KANGÜL H,GÜL S,AKDENİZ B,Güneri S "The effects of chronic usage of angiotensin-converting enzyme inhibitors and angiotensin recep-tor blockers on contrast-induced nephropathy in low-risk patients." , ss.245 - 250, 2013.
ISNAD	Baris, Nezihi vd. "The effects of chronic usage of angiotensin-converting enzyme inhibitors and angiotensin recep-tor blockers on contrast-induced nephropathy in low-risk patients". (2013), 245-250.

APA	Baris N, Ozpelit E, DOĞAN BİLGİN N, KANGÜL H, GÜL S, AKDENİZ B, Güneri S (2013). The effects of chronic usage of angiotensin-converting enzyme inhibitors and angiotensin recep-tor blockers on contrast-induced nephropathy in low-risk patients. Anadolu Kardiyoloji Dergisi, 13(3), 245 - 250.
Chicago	Baris Nezihi,Ozpelit Ebru,DOĞAN BİLGİN Nazile,KANGÜL Hande,GÜL Sefa,AKDENİZ Bahri,Güneri Sema The effects of chronic usage of angiotensin-converting enzyme inhibitors and angiotensin recep-tor blockers on contrast-induced nephropathy in low-risk patients. Anadolu Kardiyoloji Dergisi 13, no.3 (2013): 245 - 250.
MLA	Baris Nezihi,Ozpelit Ebru,DOĞAN BİLGİN Nazile,KANGÜL Hande,GÜL Sefa,AKDENİZ Bahri,Güneri Sema The effects of chronic usage of angiotensin-converting enzyme inhibitors and angiotensin recep-tor blockers on contrast-induced nephropathy in low-risk patients. Anadolu Kardiyoloji Dergisi, vol.13, no.3, 2013, ss.245 - 250.
AMA	Baris N,Ozpelit E,DOĞAN BİLGİN N,KANGÜL H,GÜL S,AKDENİZ B,Güneri S The effects of chronic usage of angiotensin-converting enzyme inhibitors and angiotensin recep-tor blockers on contrast-induced nephropathy in low-risk patients. Anadolu Kardiyoloji Dergisi. 2013; 13(3): 245 - 250.
Vancouver	Baris N,Ozpelit E,DOĞAN BİLGİN N,KANGÜL H,GÜL S,AKDENİZ B,Güneri S The effects of chronic usage of angiotensin-converting enzyme inhibitors and angiotensin recep-tor blockers on contrast-induced nephropathy in low-risk patients. Anadolu Kardiyoloji Dergisi. 2013; 13(3): 245 - 250.
IEEE	Baris N,Ozpelit E,DOĞAN BİLGİN N,KANGÜL H,GÜL S,AKDENİZ B,Güneri S "The effects of chronic usage of angiotensin-converting enzyme inhibitors and angiotensin recep-tor blockers on contrast-induced nephropathy in low-risk patients." Anadolu Kardiyoloji Dergisi, 13, ss.245 - 250, 2013.
ISNAD	Baris, Nezihi vd. "The effects of chronic usage of angiotensin-converting enzyme inhibitors and angiotensin recep-tor blockers on contrast-induced nephropathy in low-risk patients". Anadolu Kardiyoloji Dergisi 13/3 (2013), 245-250.