Impact of RAAS Blockers on Contrast-Induced Nephropathy in Patients With Renal Insufficiency: A Meta-Analysis
Impact of RAAS Blockers on Contrast-Induced Nephropathy in Patients With Renal Insufficiency: A Meta-Analysis
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RAAS 阻滞剂对肾功能不全患者对比剂肾病的影响：荟萃分析
DOI：
10.1097/fjc.0000000000000910
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发表时间：
2020
影响因子：
3
通讯作者：
Liao Xinxue
中科院分区：
文献类型：
--
作者：
Huang Yiquan;Zhang Shaozhao;Liu Menghui;Zhong Xiangbin;Lin Yifen;Xiong Zhenyu;Fan Yongqiang;Zhou Huimin;Sun Xiuting;Guo Yue;Xu Xingfeng;Li Yuqi;Yang Daya;Zhuang Xiaodong;Liao Xinxue
在肾功能不全患者中，肾素-血管紧张素-醛固酮系统（RAAS）阻滞剂[血管紧张素转换酶抑制剂（ACEI）和血管紧张素受体阻滞剂]对造影剂肾病（CIN）的影响尚不清楚。因此，我们进行了一项荟萃分析，以评估肾功能不全患者中RAAS阻滞剂给药与CIN之间的相关性。我们搜索了PubMed、EMBASE和科克伦图书馆，寻找2019年9月之前发表的相关研究。主要结局是CIN的发生率，次要结局是血清肌酐（SCr）从基线到术后的变化（Δ SCr）。采用合并比值比（OR）或加权平均差（WMD）及其95%置信区间（CI）计算CIN发生率，Delta SCr用于计算原始数据。荟萃分析共纳入8项研究。与对照组相比，ACEI/血管紧张素受体阻滞剂可增加CIN的风险（OR = 1.61，95%CI 1.14-2.28，I-2 = 30%; P = 0.007），而在中国患者中这种相关性不显著（OR = 1.07，95%CI 0.65-1.77，I-2 = 19%，P = 0.79）。Delta SCr的总加权平均差异为0.06 mg/dL（95% CI：0.01-0.11，I-2 = 82%; P = 0.03）。肾功能不全患者使用RAAS阻断剂与CIN发生率显著升高相关，而对中国患者无显著影响。
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 (Delta SCr). Pooled odds ratio (OR) or weighted mean difference (WMD) with their 95% confidence interval (CIs) for the CIN incidence, Delta SCr 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-2 = 30%; P = 0.007), whereas this association was not significant in Chinese patients (OR = 1.07, 95% CI 0.65-1.77, I-2 = 19%, P = 0.79). The total weighted mean differences of the Delta SCr were 0.06 mg/dL (95% CI: 0.01-0.11, I-2 = 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.