ACEI And Renal Function After Vascular Surgery

ACEI And Renal Function After Vascular Surgery To the Editor: I read with interest the article by Marie- Laurie Cittanova et al. (1). They have studied prospectively, the possible preoperative risk factors for predicting postoperative renal dysfunction. Multiple factors may influence a patient’s perioperative renal function (2). Hypovolemia, which can occur in the presence or absence of hypotension, causes redistribution of renal blood flow (RBF) from the outer cortex to the inner cortex and the medulla, which may affect renal functional reserve (3). Although the authors have studied ‘hypotension’ as one of the risk factors, ‘hypovolemia’ has not been addressed as a separate factor. Another important factor, which has not been addressed in this study, is exposure to salicylates and non-steroidal anti-inflammatory drugs (NSAIDs). These drugs are inhibitors of prostaglandin synthesis and are known to cause deterioration of RBF and glomerular filtration rate (GFR) in patients with decreased effective blood volume (4,5). It is possible that the result of this study, i.e., the chronic inhibition of angiotensin converting enzyme (ACE) impairs postoperative renal function, could have been confounded by these variables if the patients on ACE inhibitors also had exposure to NSAIDs or suffered hypovolemia perioperatively. Dr. P. Gayatri