Angiotensin Converting Enzyme Inhibitors & Contrast Induced Nephropathy in Patients Receiving a Cardiac Catheterization
Angiotensin Converting Enzyme Inhibitors & Contrast Induced Nephropathy in Patients Receiving a Cardiac Catheterization
The purpose of this study is to determine if patients should stop taking their angiotensin
 converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) around the time of
 their angiogram in order to prevent contrast induced nephropathy (CIN).
There are approximately 4000 coronary angiograms performed annually at the Hamilton General
 Hospital to diagnose and treat coronary artery disease. Many of the patients undergoing this
 procedure have mild kidney disease. Exposure to the contrast dye used in the procedure puts
 them at risk of worsening kidney function, a condition called contrast induced nephropathy
 (CIN) which is associated with significant morbidity and mortality. Many of these patients
 are also on an antihypertensive drug called an angiotensin converting enzyme (ACE) inhibitor
 or angiotensin receptor blocker (ARB). Their effects on the kidney during contrast exposure
 are not known. Our understanding of how the drug works leads us to believe that the use of
 these drugs around the time of contrast exposure may have detrimental effects on the kidney.

 The purpose of this study is to determine if patients should continue taking or stop taking
 their ACE inhibitor or ARB around the time of their angiogram in order to prevent CIN.

 Patients undergoing an elective coronary angiogram with mild kidney disease and currently
 taking an ACE inhibitor or ARB will be randomly divided into two groups. One group will
 continue taking their ACE inhibitor or ARB while the other group will stop taking their ACE
 inhibitor or ARB for at least 24 hours before and will resume their ACE inhibitor or ARB 48
 to 96 hours after their angiogram. In both groups, kidney function will be assessed by means
 of a simple blood test both before and 48 to 96 hours after the angiogram. By doing this, we
 can determine which group had more kidney damage and which group had less kidney damage from
 the contrast exposure. We suspect that patients who do not take their ACE inhibitor around
 the time of their angiogram will have less kidney damage. All patients will receive the
 accepted measures for preventing kidney disease from contrast dye exposure.

 CIN is associated with significant morbidity and mortality. If the use of ACEIs during
 coronary angiograms are associated with an increased risk of CIN, then these patients may
 benefit from holding their ACEI around the time of their procedure potentially improving
 their outcomes. This is a low cost intervention that could potentially change practice,
 reduce morbidity, save lives and pave the way for larger clinical trials.
Inclusion Criteria:

 -  Scheduled for Angiography in >= 24hrs from enrolment

 -  Documented Cr >= 150 within 3 months before cardiac catheterization AND/OR documented
 Cr >= 132umol/L within 1 week Before Cardiac Catheterization

 -  Currently Taking an ACE Inhibitor

 Exclusion Criteria:

 -  Patients with end stage renal disease (for example, patient on dialysis)

 -  Emergency Cardiac Catheterization with insufficient time to hold the ACEI

 -  Acute Pulmonary Edema