Faculty Bibliography

BACKGROUND: The effect of continuing or discontinuing chronic angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) therapy prior to coronary angiography on the incidence of contrast-induced nephropathy (CIN) is not clear. We undertook a randomized trial to evaluate the effect of withdrawing ACEIs or ARBs 24 h prior to coronary angiography on the incidence of CIN associated with coronary angiography. METHODS: A total of 220 patients with chronic kidney disease (CKD) stages 3-4 (glomerular filtration rate 15-60 ml/min/1.73 m2) on ACEI or ARB therapy were randomized before angiography to either ACEI/ARB continuation group or discontinuation group. A third group of patients with CKD stages 3-4 but not on angiotensin blockade therapy were also followed. The primary outcome measure was the incidence of CIN defined by a rise in serum creatinine by 25% or 0.5 mg/dl (44 micromol/l) from baseline. RESULTS: There was no statistically significant difference in the incidence of CIN between the three groups (P=0.66). The incidences were 6.2%, 3.7%, and 6.3% for the continuation, discontinuation, and angiotensin blockade naive group, respectively. There was also no significant difference found between the groups in mean serum creatinine and glomerular filtration rate values at baseline and post contrast administration. CONCLUSION: Withholding ACEIs and ARBs 24 h before coronary angiography does not appear to influence the incidence of CIN in stable patients with CKD stages 3-4

Numerous studies have analyzed the effects of family structure, composition, and resources on socioeconomic status attainment. Fewer studies have explored how these family-based factors affect the variation—or the correlation—between siblings in socioeconomic status. The current study draws on data from the Panel Study of Income Dynamics and provides a descriptive account of the correlations between siblings along a number of family composition and resource dimensions. We report two main findings. First, correlations do not vary by siblings' sex mix. That is, brothers' correlations in education, earnings, and family income are similar to sisters’ correlations. Second, siblings from relatively disadvantaged families—those with more siblings and lower educated, younger, and unmarried mothers—have lower correlations in socioeconomic status than siblings from more advantaged families. In general, family background has a weaker effect on adults who begin life from disadvantaged positions. These findings suggest that social reproduction and mobility processes are complex and shaped by family-level dynamics and resources