Preoperative use of angiotensin converting enzyme inhibitors or angiotensin receptor blockers is controversial. There are conflicting reports of their contribution to the incidence of postoperative acute kidney injury and mortality. This meta-anlysis by Yacoub et al. found that using RAS blockers before cardiovascular surgery is associated with a statistically significant 17% increased odds of postoperative kidney failure and 20% increased odds of death, potentially reflecting the inability of the kidney to respond to perioperative hemodynamic challenges.
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