This is a question that comes up during almost every consult in patients with CKD about to receive contrast exposure. Should we stop ACEi and ARBs prior to exposure?
The data is confusing as summarized in the introduction to this latest analysis:
…Some studies have demonstrated that chronic medication with angiotensin-converting enzyme inhibitors (ACE-I) or AT-1 blockers was a risk factor for CIN [19,20], whereas other studies [21,22] found a protective effect in patients with CKD when exposed to CM.
If that doesn’t meet the definition of equipoise, I don’t know what does.
When the baseline characteristics are separated by the presence of contrast nephropathy it reads like a rogues gallery of risk factors of contrast:
- Insulin dependent
- Hemoglobin (that’s new)
- RAAS blockade (ACEi, ARB, and aldo antagonist)
- Loop diuretic
- Contrast dose
The multivariate analysis showed RAAS blockade and hemoglobin to be independent predictors of contrast induced nephropathy: