Continuous Venovenous Hemofiltration After Coronary Procedures for the Prevention of Contrast-Induced Acute Kidney Injury in Patients With Severe Chronic Renal Failure

Contrast media-induced nephropathy: how has Italy contributed in the past 30 years? A systematic review

“…The authors found that venovenous hemofiltration was an efficient technique to reduce the risk of developing contrast-induced nephropathy in these patients. Guastoni et al, 45 in contrast, assessed the impact of venovenous hemofiltration in preventing contrast-induced nephropathy among patients with chronic kidney disease who underwent coronary procedures. The study included 53 patients exposed to iopamidol and showed the beneficial effect of this technique in reducing the risk of developing contrast-induced nephropathy.…”

Post‐procedural hemodiafiltration in acute coronary syndrome patients with associated renal and cardiac dysfunction undergoing urgent and emergency coronary angiography

“…Conversely, protocols demonstrating a clear benefit of RRT were initiated at least 4–6 hr before contrast exposure . Possibly, the different clinical context and the different therapeutic target could solve this apparent incongruence and explain the observed benefit of a post‐procedural RRT in our population . Indeed, while elective angiography requires a safe and controlled vigorous pre‐procedural hydration, urgent/emergency angiography needs the support of renal function during hemodynamic instability.…”

“…Several positive effects of hemodiafiltration may play a role in preventing severe AKI in patients with exhausted renal and cardiac functional reserve. Among them, control of metabolic acidosis and electrolytes abnormalities, prevention of both intravascular volume depletion (maintaining cardiac pre‐load and renal perfusion pressure) and extra‐vascular fluid overload (reducing lung congestion), and removal of possible inflammatory and vaso‐active mediators of AKI and of renal toxic substances, in particular contrast agents and uremic toxins . As contrast media are mainly excreted by glomerular filtration, when renal function is normal, the half‐life of contrast agents is ∼2 hr, but it can be prolonged to over 30 hr in patients with severe CKD, in proportion to the extent of renal impairment .…”

Intra‐procedural continuous dialysis to facilitate interventional catheterization in pediatric patients with severe renal failure

“…A few studies have demonstrated no benefit with higher risk of intradialytic hypotension when hemodialysis is performed immediately post cardiac catheterization . In contrast, continuous hemofiltration therapy has been shown to be effective in removing contrast medium when started post‐cardiac catheterization, and the use of peri‐procedural hemofiltration has been demonstrated as an effective strategy in preventing contrast induced nephropathy in patients with chronic kidney disease . Unfortunately, not much evidence is available in the pediatric population as most of the literature on this topic focuses primarily on preventing contrast‐induced nephropathy in adult patients undergoing percutaneous coronary interventions.…”