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Renal protection for coronary angiography in advanced renal failure patients by prophylactic hemodialysis : A randomized controlled trial
We performed a study to determine whether prophylactic hemodialysis reduces contrast nephropathy (CN) after coronary angiography in advanced renal failure patients. Pre-existing renal failure is the greatest risk factor for CN. Hemodialysis can effectively remove contrast media, but its effect upon...
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Published in: | Journal of the American College of Cardiology 2007-09, Vol.50 (11), p.1015-1020 |
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Main Authors: | , , , , , , , |
Format: | Article |
Language: | English |
Subjects: | |
Online Access: | Get full text |
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Summary: | We performed a study to determine whether prophylactic hemodialysis reduces contrast nephropathy (CN) after coronary angiography in advanced renal failure patients.
Pre-existing renal failure is the greatest risk factor for CN. Hemodialysis can effectively remove contrast media, but its effect upon preventing CN is still uncertain.
Eighty-two patients with chronic renal failure, referred for coronary angiography, were assigned randomly to receive either normal saline intravenously and prophylactic hemodialysis (dialysis group; n = 42) or fluid supplement only (control group; n = 40).
Prophylactic hemodialysis lessened the decrease in creatinine clearance within 72 h in the dialysis group (0.4 +/- 0.9 ml/min/1.73 m(2) vs. 2.2 +/- 2.8 ml/min/1.73 m(2); p < 0.001). Compared with the dialysis group, the serum creatinine concentrations in the control group were significantly higher at day 4 (6.3 +/- 2.3 mg/dl vs. 5.1 +/- 1.3 mg/dl; p = 0.010) and at peak level (6.7 +/- 2.7 mg/dl vs. 5.3 +/- 1.5 mg/dl; p = 0.005). Temporary renal replacement therapy was required in 35% of the control patients and in 2% of the dialysis group (p < 0.001). Thirteen percent of the control patients, but none of the dialysis patients, required long-term dialysis after discharge (p = 0.018). For the patients not requiring chronic dialysis, 13 patients in the control group (37%) and 2 in the dialysis group (5%) had an increase in serum creatinine concentration at discharge of more than 1 mg/dl from baseline (p < 0.001).
Prophylactic hemodialysis is effective in improving renal outcome in chronic renal failure patients undergoing coronary angiography. |
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ISSN: | 0735-1097 1558-3597 |
DOI: | 10.1016/j.jacc.2007.05.033 |