Comparison of two hemofiltration protocols for prevention of contrast-induced nephropathy in high-risk patients

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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.

Original languageEnglish
Pages (from-to)155-162
Number of pages8
JournalAmerican Journal of Medicine
Volume119
Issue number2
DOIs
Publication statusPublished - Feb 2006

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Keywords

  • Chronic kidney disease
  • Contrast-induced nephropathy
  • Hemofiltration

ASJC Scopus subject areas

  • Nursing(all)

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