Comparative study on effect of ACEI/ARBs and CCBs in prevention of contrast-induced nephropathy in patients with hypertension associated with chronic renal insufficiency after coronary artery intervention

AIM To evaluate the efficacy of ACEI/ARBs and CCBs in prevention of contrast-induced nephropathy (CIN) in patients with hypertension associated with chronic renal insufficiency after coronary artery intervention. METHODS We retrospectively analyzed 180 patients with 2-3 phase chronic kidney diseases (CKD) in our hospital. Patients all underwent coronary angioplasty and hydration therapy and were taking ACEI/ARBs drugs or CCBs drugs for at least 7 days prior to surgery. The control group was treated only with hydration. The number of patients who developed CIN in the three groups was compared and the level of serum creatinine (SCr) and creatinine clearance rate (CCr) 24, 48, 72 h and 7 days after coronary angioplasty were recorded. RESULTS CIN occurred in 37% of the patients (20/54) in ACEI/ARBs group, in 20% of the patients (16/80) in CCBs group and 56.5% of the patients (28/46) in hydration control group. Compared with the hydration group, CIN incidence decreased obviously in ACEI/ARBs group and CCBs group after coronary angioplasty (P<0.05, P<0.01). Incidence of CIN in CCBs group was lower than that in ACEI/ARBs group (P<0.05). Compared with preoperative levels, levels of plasma creatinine (SCr) and endogenous creatinine clearance rate (Ccr) significantly increased 24, 48, 72 h and 7 days after surgery in all three groups with significant differences. Compared with hydration control group, levels of plasma SCr and Ccr significantly decreased 24, 48, 72 h and 7 days after surgery in ACEI/ARBs group and CCBs group, with significant differences. Compared with that in ACEI/ARBs group, the SCr level 48, 72 h and 7 days after the surgery in CCBs group was lower (P<0.05). Renal functions recovered to pre-operative levels in 70% of the patients in ACEI/ARBs group at 14 days after operation, in 75% in CCBs group and in 61.5% in hydration group, with no statistical difference between ACEI/ARBs group and CCBs group. CONCLUSION ACEI/ARBs and CCBs drugs are beneficial for the prevention of CIN in patients with chronic renal failure. CCB drugs may be more effective than ACEI/ARB drugs for better prevention of CIN and shorter recovery time in patients with chronic renal failure.