There is unclear evidence on
holding ACEi/ ARB prior to coronary angiography reduces contrast induced
nephropathy (CIN). The
CAPTAIN trail just published in the American Heart Journal was a randomized
trial to investigate whether holding ACEi/ ARB prior to cardiac catheterization
reduces the incidence of contrast-induced AKI in patients with chronic kidney
disease (CKD).
Some key points:
Total of 208 patients underwent
randomization over 6 years with CKD as defined - creatinine >1.7mg/dl
w/in 3 months before cardiac
catheterization and/or serum creatinine > 1.5 mg/dl w/in 1 week
before cardiac catheterization
Primary outcome: incidence of AKI
defined as an absolute rise in Scr of >0.5 mg/dl from baseline and/or
a relative rise in Scr of > 25% compared with baseline at any time
between 48 and 96 hrs post-cardiac catheterization.
Secondary outcome: absolute difference
in post-procedure creatinine compared with baseline creatinine
Safety outcome was a composite of
CHF or hypertension after the procedure
Results of the study demonstrate
that in patients with CKD, holding compared w/ continuing ACEi/ARB prior to
cardiac catheterization, with-holding ACEi/ARB resulted in a:
1.
Non-significant reduction in contrast-induced
AKI
2.
Significant reduction in post-procedural rise of
creatinine.
3.
Study demonstrated a strong trend toward
improved clinical outcomes when ACEi/ARB was held before angiography.
4.
No adverse events were reported in the hold
ACEi/ARB group
5.
Safety: no rise in CHF or HTN with holding
ACEi/ARB therapy
This randomized trial does suggest
that in CKD patients, it might be beneficial to hold the ACEI/ARB pre cardiac cath
for some potential benefit. A larger N
would have perhaps been important to do to get a better sense of this
protective effect. A multi center study would have been useful as well.
