Research Paper Volume 12, Issue 7 pp 5858—5877

Renin-angiotensin-aldosterone system blockade is associated with higher risk of contrast-induced acute kidney injury in patients with diabetes

Mengqing Ma1, *, , Xin Wan2, *, , Min Gao1, , Binbin Pan2, , Dawei Chen2, , Qing Sun1, , Mengyu Zhang3, , Changgao Zhou4, , Tao Li4, , Hanchao Pan1, , Wei Shao1, , Zhihe Liu2, , Yue Chen2, , Changchun Cao1, ,

  • 1 Department of Nephrology, Sir Run Run Hospital, Nanjing Medical University, Nanjing 211166, Jiangsu, China
  • 2 Department of Nephrology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, Jiangsu, China
  • 3 Department of Nephrology, Xu Zhou Medical University Hospital, Xuzhou 221000, Jiangsu, China
  • 4 Department of Cardiology, Affiliated Shu Yang Hospital, Nanjing University of Traditional Chinese Medicine, Shuyang 223600, Jiangsu, China
* Equal contribution

Received: July 8, 2019       Accepted: March 24, 2020       Published: April 2, 2020
How to Cite

Copyright © 2020 Ma et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


As the incidence of diabetes and cardiovascular comorbidities continues to rise, driven by increased prevalence of obesity and an aging population, so does the demand for percutaneous coronary intervention (PCI) to restore cardiac blood flow. Renin-angiotensin-aldosterone system (RAAS) inhibitors are commonly prescribed to hypertensive diabetic patients to prevent diabetic nephropathy. However, evidence suggests that angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) may increase the risk of contrast-induced acute kidney injury (CIAKI) following coronary angiography (CAG) and PCI. We therefore conducted a retrospective, multicenter study applying the propensity score matching method to evaluate the impact of RAAS inhibition on CIAKI in diabetic patients undergoing CAG/PCI. Among 2240 subjects that met the inclusion criteria, 704 patients in the ACEIs/ARBs group were successfully matched to eligible control patients. The incidence of CIAKI (serum creatinine increase ≥0.5 mg/dl or ≥25% from baseline within 72 h post-CAG/PCI) was significantly higher in the ACEIs/ARBs group than in the control group (26.6% vs. 16.2%, P<0.001). However, control patients showed increased risk of overall adverse cardiovascular events (4.1% vs. 1.8% for ACEIs/ARBs; P=0.016). These data indicate that RAAS inhibition increases the risk of CIAKI in diabetic patients, but confers protection against early cardiovascular events.


CIAKI: contrast-induced acute kidney injury; CKD: chronic kidney disease; CHF: congestive heart failure; AMI: acute myocardial infarction; eGFR: estimated glomerular filtration rate; HDL: high-density lipoprotein; LDL: low-density lipoprotein; LVEF: left ventricular ejection fraction; CAG: coronary angiography; PCI: Percutaneous coronary intervention.