Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; and.
NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), Guangzhou, China.
J Cardiovasc Pharmacol. 2020 Dec;76(6):692-697. doi: 10.1097/FJC.0000000000000910.
The effect of renin-angiotensin-aldosterone system (RAAS) blockers [angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers] on Contrast-induced nephropathy (CIN) is unclear in patients with renal insufficiency. Thus, we conduct a meta-analysis to evaluate the association between the administration of RAAS blockers and CIN in patients with renal insufficiency. We searched PubMed, EMBASE, and Cochrane Library for relevant studies published before September 2019. The primary outcome was the incidence of CIN, and the secondary outcome was the changes in serum creatinine (SCr) from baseline to postprocedure (ΔSCr). Pooled odds ratio (OR) or weighted mean difference (WMD) with their 95% confidence interval (CIs) for the CIN incidence, ΔSCr were used to calculate original data. A total of 8 studies were included in the meta-analysis. Compared with controls, ACEI/angiotensin receptor blocker increased the risk of CIN (OR = 1.61, 95% CI 1.14-2.28, I = 30%; P = 0.007), whereas this association was not significant in Chinese patients (OR = 1.07, 95% CI 0.65-1.77, I = 19%, P = 0.79). The total weighted mean differences of the ΔSCr were 0.06 mg/dL (95% CI: 0.01-0.11, I = 82%; P = 0.03). Administration of RAAS blockers in patients with renal insufficiency was associated with a significantly higher incidence of CIN, whereas it did not show a significant effect on Chinese patients.
血管紧张素转换酶抑制剂（ACEI）和血管紧张素受体阻滞剂（ARB）等肾素-血管紧张素-醛固酮系统（RAAS）阻滞剂对肾功能不全患者的造影剂肾病（CIN）的影响尚不清楚。因此，我们进行了一项荟萃分析，以评估 RAAS 阻滞剂在肾功能不全患者中的应用与 CIN 之间的相关性。我们检索了 PubMed、EMBASE 和 Cochrane Library 中截至 2019 年 9 月发表的相关研究。主要结局为 CIN 的发生率，次要结局为术后血清肌酐（SCr）的变化（ΔSCr）。使用合并优势比（OR）或加权均数差（WMD）及其 95%置信区间（CIs）计算 CIN 发生率和ΔSCr 的原始数据。荟萃分析共纳入 8 项研究。与对照组相比，ACEI/ARB 增加了 CIN 的风险（OR=1.61，95%CI 1.14-2.28，I²=30%，P=0.007），而在中国人中这种相关性不显著（OR=1.07，95%CI 0.65-1.77，I²=19%，P=0.79）。ΔSCr 的总加权均数差为 0.06mg/dL（95%CI：0.01-0.11，I²=82%，P=0.03）。在肾功能不全患者中使用 RAAS 阻滞剂与 CIN 发生率显著升高相关，而对中国患者则没有显著影响。
