The prevention of contrast-induced nephropathy by simultaneous hemofiltration during coronary angiographic procedures: A comparison with periprocedural hemofiltration.

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The prevention of contrast-induced nephropathy by simultaneous hemofiltration during coronary angiographic procedures: A comparison with periprocedural hemofiltration.

Int J Cardiol. 2014 Aug 23;

Authors: Choi MJ, Yoon JW, Han SJ, Choi HH, Song YR, Kim SG, Oh JE, Lee YK, Seo JW, Kim HJ, Noh JW, Koo JR

Abstract
BACKGROUND: Periprocedural (6h pre- and 24h post-angiography) hemofiltration appears to effectively prevent contrast-induced nephropathy (CIN) in chronic kidney disease (CKD) patients undergoing coronary angiography. However, this procedure over-uses medical resources, and the cessation of hemofiltration during coronary angiography results in persistent renal injury. In comparison, simultaneous hemofiltration performed only during coronary angiography requires fewer medical resources and can provide instantaneous protection against CIN.
METHODS: Sixty-eight CKD patients (serum creatinine, 2.51±1.15mg/dL) undergoing coronary angiography were randomized in a 1:2 ratio to receive either periprocedural (n=23) or simultaneous (n=45) hemofiltration. The expected CIN rate was similar for the two groups (41.3% versus 40.0%, p=0.769).
RESULTS: On day 3 after contrast exposure, four and seven patients in the periprocedural and simultaneous groups, respectively experienced CIN (17.4% versus 15.6%, p=0.846). On days 5-30, seven and three patients in the periprocedural and simultaneous groups, respectively experienced CIN (30.4% versus 6.7%, p=0.009). The serum creatinine levels of patients in the periprocedural group transiently decreased on day 1 and persistently increased during days 5-30 compared with the simultaneous group. This difference between the two groups in terms of creatinine levels over time was statistically significant (F statistic=6.830; p=0.001, by ANCOVA). The cost of hemofiltration was doubled in the periprocedural group ($1066±83 versus $504±40, p<0.001).
CONCLUSIONS: Simultaneous hemofiltration provide equal early (day 3) and better late-stage (days 5-30) renal protection against CIN at a significantly lower cost compared with periprocedural hemofiltration.

PMID: 25200848 [PubMed - as supplied by publisher]

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