The prevention of radiocontrast-agent-induced nephropathy by hemofiltration

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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 languageEnglish
Pages (from-to)1333-1340
Number of pages8
JournalNew England Journal of Medicine
Volume349
Issue number14
DOIs
Publication statusPublished - Oct 2 2003

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Hemofiltration
Contrast Media
Creatinine
Serum
Renal Insufficiency
Percutaneous Coronary Intervention
Chronic Kidney Failure
Intensive Care Units
Weight Loss
Body Weight
Morbidity
Control Groups
Mortality

ASJC Scopus subject areas

  • Medicine(all)

Cite this

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title = "The prevention of radiocontrast-agent-induced nephropathy by hemofiltration",
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",
author = "Giancarlo Marenzi and Ivana Marana and Gianfranco Lauri and Emilio Assanelli and Marco Grazi and Jeness Campodonico and Daniela Trabattoni and Franco Fabbiocchi and Piero Montorsi and Bartorelli, {Antonio L.}",
year = "2003",
month = "10",
day = "2",
doi = "10.1056/NEJMoa023204",
language = "English",
volume = "349",
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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 -