Abstract
BACKGROUND: Nephropathy induced by exposure to radiocontrast agents, a possible complication of percutaneous coronary interventions, is associated with significant in-hospital and long-term morbidity and mortality. Patients with preexisting renal failure are at particularly high risk. We investigated the role of hemofiltration, as compared with isotonic-saline hydration, in preventing contrast-agent-induced nephropathy in patients with renal failure. METHODS: We studied 114 consecutive patients with chronic renal failure (serum creatinine concentration, >2 mg per deciliter [176.8 μmol per liter]) who were undergoing coronary interventions. We randomly assigned them to either hemofiltration in an intensive care unit (ICU) (58 patients, with a mean [±SD] serum creatinine concentration of 3.0±1.0 mg per deciliter [265.2±88.4 μmol per liter]) or isotonic-saline hydration at a rate of 1 ml per kilogram of body weight per hour given in a step-down unit (56 patients, with a mean serum creatinine concentration of 3.1±1.0 mg per deciliter [274.0±88.4 μmol per liter]). Hemofiltration (fluid replacement rate, 1000 ml per hour without weight loss) and saline hydration were initiated 4 to 8 hours before the coronary intervention and were continued for 18 to 24 hours after the procedure was completed. RESULTS: An increase in the serum creatinine concentration of more than 25 percent from the base-line value after the coronary intervention occurred less frequently among the patients in the hemofiltration group than among the control patients (5 percent vs. 50 percent, P
| Original language | English |
|---|---|
| Pages (from-to) | 1333-1340 |
| Number of pages | 8 |
| Journal | New England Journal of Medicine |
| Volume | 349 |
| Issue number | 14 |
| DOIs | |
| Publication status | Published - Oct 2 2003 |
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The prevention of radiocontrast-agent-induced nephropathy by hemofiltration. / Marenzi, Giancarlo; Marana, Ivana; Lauri, Gianfranco; Assanelli, Emilio; Grazi, Marco; Campodonico, Jeness; Trabattoni, Daniela; Fabbiocchi, Franco; Montorsi, Piero; Bartorelli, Antonio L.
In: New England Journal of Medicine, Vol. 349, No. 14, 02.10.2003, p. 1333-1340.Research output: Contribution to journal › Article
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TY - JOUR
T1 - The prevention of radiocontrast-agent-induced nephropathy by hemofiltration
AU - Marenzi, Giancarlo
AU - Marana, Ivana
AU - Lauri, Gianfranco
AU - Assanelli, Emilio
AU - Grazi, Marco
AU - Campodonico, Jeness
AU - Trabattoni, Daniela
AU - Fabbiocchi, Franco
AU - Montorsi, Piero
AU - Bartorelli, Antonio L.
PY - 2003/10/2
Y1 - 2003/10/2
N2 - BACKGROUND: Nephropathy induced by exposure to radiocontrast agents, a possible complication of percutaneous coronary interventions, is associated with significant in-hospital and long-term morbidity and mortality. Patients with preexisting renal failure are at particularly high risk. We investigated the role of hemofiltration, as compared with isotonic-saline hydration, in preventing contrast-agent-induced nephropathy in patients with renal failure. METHODS: We studied 114 consecutive patients with chronic renal failure (serum creatinine concentration, >2 mg per deciliter [176.8 μmol per liter]) who were undergoing coronary interventions. We randomly assigned them to either hemofiltration in an intensive care unit (ICU) (58 patients, with a mean [±SD] serum creatinine concentration of 3.0±1.0 mg per deciliter [265.2±88.4 μmol per liter]) or isotonic-saline hydration at a rate of 1 ml per kilogram of body weight per hour given in a step-down unit (56 patients, with a mean serum creatinine concentration of 3.1±1.0 mg per deciliter [274.0±88.4 μmol per liter]). Hemofiltration (fluid replacement rate, 1000 ml per hour without weight loss) and saline hydration were initiated 4 to 8 hours before the coronary intervention and were continued for 18 to 24 hours after the procedure was completed. RESULTS: An increase in the serum creatinine concentration of more than 25 percent from the base-line value after the coronary intervention occurred less frequently among the patients in the hemofiltration group than among the control patients (5 percent vs. 50 percent, P
AB - BACKGROUND: Nephropathy induced by exposure to radiocontrast agents, a possible complication of percutaneous coronary interventions, is associated with significant in-hospital and long-term morbidity and mortality. Patients with preexisting renal failure are at particularly high risk. We investigated the role of hemofiltration, as compared with isotonic-saline hydration, in preventing contrast-agent-induced nephropathy in patients with renal failure. METHODS: We studied 114 consecutive patients with chronic renal failure (serum creatinine concentration, >2 mg per deciliter [176.8 μmol per liter]) who were undergoing coronary interventions. We randomly assigned them to either hemofiltration in an intensive care unit (ICU) (58 patients, with a mean [±SD] serum creatinine concentration of 3.0±1.0 mg per deciliter [265.2±88.4 μmol per liter]) or isotonic-saline hydration at a rate of 1 ml per kilogram of body weight per hour given in a step-down unit (56 patients, with a mean serum creatinine concentration of 3.1±1.0 mg per deciliter [274.0±88.4 μmol per liter]). Hemofiltration (fluid replacement rate, 1000 ml per hour without weight loss) and saline hydration were initiated 4 to 8 hours before the coronary intervention and were continued for 18 to 24 hours after the procedure was completed. RESULTS: An increase in the serum creatinine concentration of more than 25 percent from the base-line value after the coronary intervention occurred less frequently among the patients in the hemofiltration group than among the control patients (5 percent vs. 50 percent, P
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U2 - 10.1056/NEJMoa023204
DO - 10.1056/NEJMoa023204
M3 - Article
C2 - 14523141
AN - SCOPUS:0141542636
VL - 349
SP - 1333
EP - 1340
JO - New England Journal of Medicine
JF - New England Journal of Medicine
SN - 0028-4793
IS - 14
ER -