Comparison of Two Hemofiltration Protocols for Prevention of Contrast-induced Nephropathy in High-risk Patients - 18/08/11
, Gianfranco Lauri, MD, Jeness Campodonico, MD, Ivana Marana, MD, Emilio Assanelli, MD, Monica De Metrio, MD, Marco Grazi, MD, Fabrizio Veglia, PhD, Franco Fabbiocchi, MD, Piero Montorsi, MD, Antonio L. Bartorelli, MD
Requests for reprints should be addressed to Giancarlo Marenzi, MD, Centro Cardiologico Monzino, Via Parea 4, 20138 Milan, Italy.Abstract |
Purpose |
Contrast-induced nephropathy is a complication of contrast medium administration during diagnostic and interventional procedures, with important prognostic relevance. Patients with chronic kidney disease have a higher risk for contrast-induced nephropathy and poorer outcome. In patients with chronic kidney disease, hemofiltration reduces contrast-induced nephropathy incidence and improves long-term survival. We assessed the mechanisms involved in the prophylactic effect of hemofiltration and of the most effective hemofiltration protocol to prevent contrast-induced nephropathy in patients with chronic kidney disease.
Subjects and methods |
We randomized 92 patients with chronic kidney disease (creatinine clearance ≤30 mL/min) to three different prophylactic treatments: intravenous hydration with isotonic saline (1 mL · kg · h for 12 hours before and after contrast exposure, control group; n = 30); intravenous hydration for 12 hours before contrast exposure, followed by hemofiltration for 18 to 24 hours after contrast exposure (post-hemofiltration group; n = 31), and hemofiltration performed for 6 hours before and for 18 to 24 hours after contrast exposure (pre/post-hemofiltration group; n = 31). The incidence of contrast-induced nephropathy (>25% increase in creatinine) and the in-hospital clinical course were compared in the three groups.
Results |
Twelve patients (40%) in the control group, 8 patients (26%) in the post-hemofiltration group, and 1 patient (3%) in the pre/post-hemofiltration group experienced contrast-induced nephropathy (P = .0013); hemodialysis was required in 9 (30%), three (10%), and zero (0%) patients, respectively (P = .002). In-hospital mortality was 20%, 10%, and 0%, respectively (P = .03).
Conclusions |
Hemofiltration is an effective strategy for contrast-induced nephropathy prevention in patients with chronic kidney disease who are undergoing cardiovascular procedures. Pre-hemofiltration is required to obtain the full clinical benefit, suggesting that, among different mechanisms possibly involved, high-volume controlled hydration before contrast media exposure plays a major role.
Le texte complet de cet article est disponible en PDF.Keywords : Hemofiltration, Contrast-induced nephropathy, Chronic kidney disease
Plan
Vol 119 - N° 2
P. 155-162 - février 2006 Retour au numéro
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