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Discontinuation of Chronic RAAS Inhibitor Therapy at Time of Contrast Media Administration Reduces Degree of Kidney Injury in an Animal Model
Author(s) -
Lauver D. Adam,
Parsh Jessica I.,
Gurm Hitinder S.
Publication year - 2017
Publication title -
the faseb journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.709
H-Index - 277
eISSN - 1530-6860
pISSN - 0892-6638
DOI - 10.1096/fasebj.31.1_supplement.998.2
Subject(s) - medicine , discontinuation , lisinopril , conventional pci , creatinine , urology , kidney , losartan , acute kidney injury , renal function , percutaneous coronary intervention , angiotensin converting enzyme , ace inhibitor , renin–angiotensin system , blood pressure , myocardial infarction
It is not known if and when angiotensin‐converting enzyme inhibitors (ACEi) and angiotensin II receptor blockers (ARB) should be discontinued prior to iodinated contrast media (CM) exposure during percutaneous intervention (PCI). Sixteen male New Zealand white rabbits (2.2 – 3.1 kg) were dosed with oral lisinopril or losartan until serum creatinine (SCr) reached steady state. The animals were then administered CM by slow intravenous infusion over 30 min (5.0 g I/kg ioxilan). In half the animals, ACEi or ARB was discontinued on day of CM whereas the other animals were continued on the agents. SCr was measured at time of CM, 1, 2, 24 and 48 hours after CM. Animals were euthanized at 48 hours and kidneys were prepared for histological evaluation. Results were compared to those from 7 control animals who only received CM. SCr stabilized at 7 days after ACEi or ARB initiation. Most (56%) developed contrast‐induced acute kidney injury as defined by SCr increase of greater than 0.5 mg/dl. At 48 hours, SCr values were greater in the animals maintained on ACEi or ARB with a SCr value of 4.03 ± 0.6 (mean ± SEM) in the continued group and 2.24 ± 0.70 in the held group (p‐value = 0.06). Our study demonstrates that continuation of either ACEi or ARB in setting of CM may worsen kidney injury. Further investigation in human subjects of the optimal timing of discontinuation of these agents, in terms of renal protection, prior to CM during PCI or other procedures is needed.