This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (23) Citing Articles via Google Scholar Google Scholar Articles by Cittanova, M.-L. Articles by Coriat, P. Search for Related Content PubMed PubMed Citation Articles by Cittanova, M.-L. Articles by Coriat, P. Related Collections Critical Care Heart

---

CARDIOVASCULAR ANESTHESIA

The Chronic Inhibition of Angiotensin-Converting Enzyme Impairs Postoperative Renal Function

Département d’Anesthésie-Réanimation, Groupe Hospitalier Pitié-Salpêtrière, Université Paris VI, Paris, France

Address correspondence and reprint requests to Dr. M. L. Cittanova, Département d’Anesthésie-Réanimation, Groupe Hospitalier Pitié-Salpêtrière, 47 Boulevard de l’Hôpital, 75651 Paris Cedex 13, France. Address e-mail to marie-laure.cittanova{at}psl.ap-hop-paris.fr

Postoperative renal impairment can increase postoperative mortality and morbidity. We sought to identify preoperative risk factors responsible for postoperative renal impairment in patients undergoing aortic surgery. This prospective study included 249 patients admitted for aortic surgery. Preoperative and postoperative glomerular filtration rates (GFRs) were assessed with pre- and postoperative creatinine clearance measurements. Postoperative renal impairment was defined as a 20% decrease in GFR between Day 0 (before surgery) and Day 7 ±1 day (after surgery). Preoperative and intraoperative variables considered as potentially responsible for postoperative renal impairment were tested. Chronic treatment with angiotensin-converting enzyme inhibitors (ACEIs) was the only factor significantly associated with postoperative renal impairment (odds ratio [95% confidence interval] = 2.01 [1.05–3.83]). Chronic preoperative ACEI treatment is significantly associated with postoperative renal impairment. Inhibition of renal compensatory mechanisms caused by renin angiotensin system blockade might be responsible for the observed decrease in renal function in patients chronically treated with ACEIs undergoing aortic surgery. However, age and preoperative renal dysfunction were not associated with a postoperative decrease in GFR, but they were associated with a postoperative creatinine clearance <60 mL/min.

IMPLICATIONS: The aim of this study was to identify preoperative risk factors responsible for postoperative renal impairment in vascular surgery. Chronic angiotensin-converting enzyme inhibitor treatment was the only factor significantly associated with postoperative renal impairment. Inhibition of renal compensatory mechanisms caused by renin angiotensin system blockade might be responsible for the observed decreased renal function.

This article has been cited by other articles:

				A. Miceli, R. Capoun, C. Fino, P. Narayan, A. J. Bryan, G. D. Angelini, and M. Caputo Effects of Angiotensin-Converting Enzyme Inhibitor Therapy on Clinical Outcome in Patients Undergoing Coronary Artery Bypass Grafting J. Am. Coll. Cardiol., November 3, 2009; 54(19): 1778 - 1784. [Abstract] [Full Text] [PDF]

				M. Najafi, H. Goodarzynejad, A. Karimi, A. Ghiasi, H. Soltaninia, M. Marzban, A. Salehiomran, B. Alinejad, and M. Soleymanzadeh Is preoperative serum creatinine a reliable indicator of outcome in patients undergoing coronary artery bypass surgery? J. Thorac. Cardiovasc. Surg., February 1, 2009; 137(2): 304 - 308. [Abstract] [Full Text] [PDF]

				P. Arora, S. Rajagopalam, R. Ranjan, H. Kolli, M. Singh, R. Venuto, and J. Lohr Preoperative Use of Angiotensin-Converting Enzyme Inhibitors/Angiotensin Receptor Blockers Is Associated with Increased Risk for Acute Kidney Injury after Cardiovascular Surgery Clin. J. Am. Soc. Nephrol., September 1, 2008; 3(5): 1266 - 1273. [Abstract] [Full Text] [PDF]

				G. Lindvall, U. Sartipy, T. Ivert, and J. van der Linden Aprotinin is Not Associated With Postoperative Renal Impairment After Primary Coronary Surgery Ann. Thorac. Surg., July 1, 2008; 86(1): 13 - 19. [Abstract] [Full Text] [PDF]

				B. G. Loef, R. H. Henning, G. Navis, A. J. Rankin, W. van Oeveren, T. Ebels, and A. H. Epema Changes in glomerular filtration rate after cardiac surgery with cardiopulmonary bypass in patients with mild preoperative renal dysfunction Br. J. Anaesth., June 1, 2008; 100(6): 759 - 764. [Abstract] [Full Text] [PDF]

				J. W. Sear Kidney dysfunction in the postoperative period Br. J. Anaesth., July 1, 2005; 95(1): 20 - 32. [Abstract] [Full Text] [PDF]

				M. Stafford-Smith Evidence-Based Renal Protection in Cardiac Surgery Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 2005; 9(1): 65 - 76. [Abstract] [PDF]

				F. Wang, J.-Y. Dupuis, H. Nathan, and K. Williams An Analysis of the Association Between Preoperative Renal Dysfunction and Outcome in Cardiac Surgery: Estimated Creatinine Clearance or Plasma Creatinine Level as Measures of Renal Function,* Chest, November 1, 2003; 124(5): 1852 - 1862. [Abstract] [Full Text] [PDF]

				D. N. Wijeysundera, V. Rao, W. S. Beattie, J. Ivanov, and K. Karkouti Evaluating Surrogate Measures of Renal Dysfunction After Cardiac Surgery Anesth. Analg., May 1, 2003; 96(5): 1265 - 1273. [Abstract] [Full Text] [PDF]

				J. Boldt and H.-J. Priebe Intravascular Volume Replacement Therapy with Synthetic Colloids: Is There an Influence on Renal Function? Anesth. Analg., February 1, 2003; 96(2): 376 - 382. [Abstract] [Full Text] [PDF]

				P. Colson, F. Ryckwaert, and M.-L. Cittanova ACE Inhibitor and Postoperative Renal Dysfunction * Response Anesth. Analg., August 1, 2002; 95(2): 499 - 500. [Full Text] [PDF]

				P. Gayatri and M. L. Cittanova ACEI And Renal Function After Vascular Surgery * Response Anesth. Analg., August 1, 2002; 95(2): 503 - 503. [Full Text] [PDF]