TY - JOUR
T1 - Effects of two different treatments with continuous renal replacement therapy in patients with chronic renal dysfunction submitted to coronary invasive procedures
AU - Spini, Valentina
AU - Cecchi, Emanuele
AU - Chiostri, Marco
AU - Landi, Daniele
AU - Romano, Salvatore Mario
AU - Mattesini, Alessio
AU - Gensini, Gian Franco
AU - Giglioli, Cristina
PY - 2013/2
Y1 - 2013/2
N2 - Background: Percutaneous coronary intervention (PCI) requires the use of iodinated contrast medium and consequently poses the risk of contrast-induced nephropathy (CIN), which can negatively impact on outcome. Patients with chronic kidney disease (CKD) are at particularly high risk of CIN. In this study, we investigated the role of continuous renal replacement therapy (CRRT) performed before and after versus only after PCI in patients with CKD. Methods: We studied 46 consecutive patients with CKD (mean creatinine >2 mg/dL) submitted to PCI: 21 (mean creatinine 2.7 ± 1.6 mg/dL) treated with CRRT only after PCI (CRRTpost) and 25 (mean creatinine 3.0 ± 1.3 mg/dL) with CRRT before and after PCI (CRRTpre-post). CRRT was performed with hemofiltration (creatinine 3 mg/dL), initiated 6-8 hours before PCI and re-started immediately post PCI for 18-24 hours. Results: Creatinine showed a greater reduction in CRRTpre-post (2.4 ± 1.0 vs 3.0 ± 1.3 mg/dL; P≤.002) with respect to CRRTpost (2.6 ± 1.3 vs 2.7 ± 1.6 mg/dL; P≤.667). At median 14.7-month follow-up, CKD worsened in 3 patients (12%) of CRRTpre-post and in 9 (43%) of CRRTpost (P≤.042). Kaplan-Meier analysis at 18 months showed a significantly higher overall mortality in patients treated with CRRTpre-post vs CRRTpost (P≤.041), which became even more significant during the entire follow-up period (P≤.026) and an increase in cardiovascular deaths (5 vs 0, respectively). Conclusions: Our results suggest that in CKD patients undergoing PCI, CRRT performed before and after is more effective in preventing a further deterioration of renal function and is associated with an improved long-term outcome when compared to CRRT performed only after.
AB - Background: Percutaneous coronary intervention (PCI) requires the use of iodinated contrast medium and consequently poses the risk of contrast-induced nephropathy (CIN), which can negatively impact on outcome. Patients with chronic kidney disease (CKD) are at particularly high risk of CIN. In this study, we investigated the role of continuous renal replacement therapy (CRRT) performed before and after versus only after PCI in patients with CKD. Methods: We studied 46 consecutive patients with CKD (mean creatinine >2 mg/dL) submitted to PCI: 21 (mean creatinine 2.7 ± 1.6 mg/dL) treated with CRRT only after PCI (CRRTpost) and 25 (mean creatinine 3.0 ± 1.3 mg/dL) with CRRT before and after PCI (CRRTpre-post). CRRT was performed with hemofiltration (creatinine 3 mg/dL), initiated 6-8 hours before PCI and re-started immediately post PCI for 18-24 hours. Results: Creatinine showed a greater reduction in CRRTpre-post (2.4 ± 1.0 vs 3.0 ± 1.3 mg/dL; P≤.002) with respect to CRRTpost (2.6 ± 1.3 vs 2.7 ± 1.6 mg/dL; P≤.667). At median 14.7-month follow-up, CKD worsened in 3 patients (12%) of CRRTpre-post and in 9 (43%) of CRRTpost (P≤.042). Kaplan-Meier analysis at 18 months showed a significantly higher overall mortality in patients treated with CRRTpre-post vs CRRTpost (P≤.041), which became even more significant during the entire follow-up period (P≤.026) and an increase in cardiovascular deaths (5 vs 0, respectively). Conclusions: Our results suggest that in CKD patients undergoing PCI, CRRT performed before and after is more effective in preventing a further deterioration of renal function and is associated with an improved long-term outcome when compared to CRRT performed only after.
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M3 - Article
C2 - 23388226
AN - SCOPUS:84876887344
VL - 25
SP - 80
EP - 84
JO - Journal of Invasive Cardiology
JF - Journal of Invasive Cardiology
SN - 1042-3931
IS - 2
ER -