HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) All Versions of this Article: CJN.05271107v1 3/5/1266    most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Arora, P. Articles by Lohr, J. Search for Related Content PubMed PubMed Citation Articles by Arora, P. Articles by Lohr, J.

Preoperative Use of Angiotensin-Converting Enzyme Inhibitors/Angiotensin Receptor Blockers Is Associated with Increased Risk for Acute Kidney Injury after Cardiovascular Surgery

Pradeep Arora^*,, Srini Rajagopalam, Rajiv Ranjan^*,, Hari Kolli, Manpreet Singh, Rocco Venuto, and James Lohr^*,

^* Division of Nephrology, Veterans Administration Medical Center, and Division of Nephrology, State University of New York at Buffalo; and Med Data Analytic, Williamsville, New York

Correspondence: Dr. James Lohr, Division of Nephrology, VAMC, 3495 Bailey Avenue, Buffalo, NY 14215. Phone: 716-862-3204; Fax: 716-862-6784; E-mail: James.Lohr{at}med.va.gov

Background and objectives: Acute kidney injury (AKI) occurs commonly after cardiac surgery. Most patients who undergo cardiac surgery receive long-term treatment with angiotensin-converting enzyme inhibitors (ACEI) or angiotensin II receptor blockers (ARB). The aim of this study was to determine whether long-term use of ACEI/ARB is associated with an increased incidence of AKI after cardiac surgery.

Design, setting, participants, & measurements: This was a retrospective cohort study of 1358 adult patients who underwent cardiac surgery between January 1, 2001, and December 31, 2005, in two tertiary care hospitals in Buffalo, NY. The incidence of AKI was determined after cardiac surgery. Clinical data were collected using a standardized form that included comorbid condition, use of ACEI/ARB, and intraoperative and postoperative complications.

Results: Overall, 40.2% of patients developed AKI. Preoperative variables that were significantly associated with development of AKI included increasing age; nonwhite race; combined valve surgery and coronary artery bypass grafting compared with coronary artery bypass grafting alone; American Society of Anesthesiologists (ASA) Risk Score category 4/5 compared with 2 to 3; presence of diabetes, congestive heart failure, or neurologic disease at baseline; use of ACEI/ARB; and emergency surgery. Intra- and postoperative factors that were associated with postoperative AKI were hypotension during surgery, use of vasopressors, and postoperative hypotension. Multiple regression logistic model confirmed an independent and significant association of AKI and preoperative use of ACEI/ARB. This was confirmed using a bivariate-probit and propensity score model that adjusts for confounding by indication of use and selection bias.

Conclusions: Preoperative use of ACEI/ARB is associated with a 27.6% higher risk for AKI postoperatively. Stopping ACEI or ARB before cardiac surgery may reduce the incidence of AKI.

This article has been cited by other articles:

				A. Miceli, R. Capoun, C. Fino, P. Narayan, A. J. Bryan, G. D. Angelini, and M. Caputo Effects of Angiotensin-Converting Enzyme Inhibitor Therapy on Clinical Outcome in Patients Undergoing Coronary Artery Bypass Grafting J. Am. Coll. Cardiol., November 3, 2009; 54(19): 1778 - 1784. [Abstract] [Full Text] [PDF]

				U. Benedetto, R. Luciani, M. Goracci, F. Capuano, S. Refice, E. Angeloni, A. Roscitano, and R. Sinatra Miniaturized cardiopulmonary bypass and acute kidney injury in coronary artery bypass graft surgery. Ann. Thorac. Surg., August 1, 2009; 88(2): 529 - 535. [Abstract] [Full Text] [PDF]

				A. Bouzas-Mosquera, N. Alvarez-Garcia, and J. Peteiro Angiotensin-converting enzyme inhibitors and risk of acute kidney injury after cardiac surgery. Ann. Thorac. Surg., May 1, 2009; 87(5): 1653 - 1653. [Full Text] [PDF]

				U. Benedetto, G. Melina, S. Refice, A. Roscitano, E. Angeloni, and R. Sinatra Reply. Ann. Thorac. Surg., May 1, 2009; 87(5): 1653 - 1654. [Full Text] [PDF]

				M.A.C. Onuigbo Reno-prevention vs. reno-protection: a critical re-appraisal of the evidence-base from the large RAAS blockade trials after ontarget--a call for more circumspection QJM, March 1, 2009; 102(3): 155 - 167. [Abstract] [Full Text] [PDF]

				N. Lameire, W. Van Biesen, E. Hoste, and R. Vanholder The prevention of acute kidney injury: an in-depth narrative review Part 1: volume resuscitation and avoidance of drug- and nephrotoxin-induced AKI NDT Plus, December 1, 2008; 1(6): 392 - 402. [Abstract] [Full Text] [PDF]