THE EFFECT OF RENIN-ANGIOTENSIN SYSTEM BLOCKING AGENTS ON THE RISK OF CON- TRAST-INDUCED NEPHROPATHY AND EARLY DETECTION WITH NEUTROPHIL GELATINASE- ASSOCIATED LIPOCALIN IN DIABETIC PATIENTS UNDERGOING CORONARY PROCEDURES

HUSEYIN GOKSULUK

Kerim Esenboğa, MD, Nurten Kerimli, MD Yusuf Atmaca, Professor Ankara University, Cardiology Department, Ankara, Turkey

Introduction: Contrast-induced nephropathy (CIN) is a common cause of hospital-acquired acute kidney injury (AKI). Plasma neutrophil gelatinase-associated lipocalin (NGAL) appears to be a novel, non-invasive, early biomarker of AKI that was detected earlier than serum creatinine (SCr). We aimed to evaluate the effect of chronic renin-angiotensin system blockers (RASB) use on the development of CIN in diabetic patients undergoing cardiac procedures.

Materials and methods: A total of 161 consecutive diabetic patients who underwent diagnostic and / or interventional coro- nary procedures were assessed for CIN. Patients were divided into two groups: Group I: RASB not stopped before the procedure (n=81), Group II: RASB stopped before the procedure (n=80). Plasma NGAL levels and SCr were measured at baseline and postpro- cedural.

Results: Contrast-induced-nephropathy was more prevalent in group I than in group II (25% vs. 11%, p=0.026, respectively). Multivariate analysis demonstrated that RASB use was 3.1 times more likely to have CIN than RASB discontinuing patients (95% CI: 1.25-8.19; p = 0.016). Other independent predictor of CIN was hypertension (OR: 9.15; 95% CI: 1.52-54.99; p = 0.025). Diabetic nephropathy tended to be related with the predicting of contrast induced nephropathy by multivariate analysis (OR: 2.39; 95% CI:0.92-6.21; p=0.07). Postprocedural plasma NGAL level was higher at 4. hour in CIN(+) patients compared to CIN(-) patients.

Conclusion: The present study demonstrated that withholding RASBs prior to coronary procedures might prevent CIN in dia- betic patients with normal renal function. NGAL level appears to be of diagnostic value earlier when compared to SCr for AKI after contrast exposure.