Department of Nephrology, The First Hospital of China Medical University, People's Republic of China.
J Renin Angiotensin Aldosterone Syst. 2020 Apr-Jun;21(2):1470320320919587. doi: 10.1177/1470320320919587.
The purpose of this study was to systematically evaluate the effect of renin-angiotensin-aldosterone system blockers on the incidence of contrast-induced nephropathy in patients undergoing coronary angiography or percutaneous coronary intervention.
A systematic literature search of several databases was conducted to identify studies that met the inclusion criteria. A total of 12 studies with 14 trials that performed studies on a total of 4864 patients (2484 treated with renin-angiotensin-aldosterone system blockers and 2380 in the control group) were included. The primary endpoint was the overall incidence of contrast-induced nephropathy. Analyses were performed with STATA version 12.0.
The overall contrast-induced nephropathy incidence in renin-angiotensin-aldosterone system blocker and control groups was 10.43% and 6.81%, respectively. The pooled relative risk of contrast-induced nephropathy incidence was 1.22 (95% confidence interval: 0.81-1.84) in the renin-angiotensin-aldosterone system blocker group. An increased risk of developing contrast-induced nephropathy in the renin-angiotensin-aldosterone system blocker group was observed among older people, non-Asians, chronic users, and studies with larger sample size, and the pooled RRs and 95% confidence intervals were 2.02 (1.21-3.36), 2.30 (1.41-3.76), 1.69 (1.10-2.59) and 1.83 (1.28-2.63), respectively.
Intervention with renin-angiotensin-aldosterone system blockers was associated with an increased risk of contrast-induced nephropathy among non-Asians, chronic users, older people, and studies with larger sample size. Large clinical trials with strict inclusion criteria are needed to confirm our results and to evaluate the effect further.
本研究旨在系统评估肾素-血管紧张素-醛固酮系统阻滞剂对接受冠状动脉造影或经皮冠状动脉介入治疗的患者对比剂肾病发生率的影响。
系统检索多个数据库以确定符合纳入标准的研究。共纳入 12 项研究，其中 14 项研究共纳入 4864 例患者（2484 例接受肾素-血管紧张素-醛固酮系统阻滞剂治疗，2380 例在对照组）。主要终点为对比剂肾病的总发生率。采用 STATA 版本 12.0 进行分析。
肾素-血管紧张素-醛固酮系统阻滞剂组和对照组对比剂肾病总发生率分别为 10.43%和 6.81%。肾素-血管紧张素-醛固酮系统阻滞剂组对比剂肾病发生率的合并相对风险为 1.22（95%置信区间：0.81-1.84）。在老年人、非亚洲人、慢性使用者和样本量较大的研究中，肾素-血管紧张素-醛固酮系统阻滞剂组发生对比剂肾病的风险增加，合并相对风险比及其 95%置信区间分别为 2.02（1.21-3.36）、2.30（1.41-3.76）、1.69（1.10-2.59）和 1.83（1.28-2.63）。
非亚洲人、慢性使用者、老年人以及样本量较大的研究中，肾素-血管紧张素-醛固酮系统阻滞剂干预与对比剂肾病风险增加相关。需要进行严格纳入标准的大型临床试验来证实我们的结果并进一步评估其影响。
