Meta-analysis of effect of renin–angiotensin–aldosterone system blockers on contrast-induced nephropathy

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.