Does Post-angiographic Hemodialysis Reduce the Risk of Contrast-medium Nephropathy?

Sterner, Gunnar; Frennby, Bo; Kurkus, Jan; Nyman, Ulf

doi:10.1080/003655900750048350

Cited by 64 publications

(29 citation statements)

References 23 publications

(54 reference statements)

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“…Although contrast can be effectively eliminated by hemodialysis and hemofiltration [8,9], it is still controversial whether RRT is able to reduce the incidence of CI-AKI. Several randomized controlled trials (RCTs) were conducted on this issue [10,11,12,13,14,15,16,17,18], but the results have been inconsistent.…”

Section: Introductionmentioning

confidence: 99%

Renal Replacement Therapy for Prevention of Contrast-Induced Acute Kidney Injury: A Meta-Analysis of Randomized Controlled Trials

et al. 2010

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Background: Contrast-induced acute kidney injury (CI-AKI) is an important cause of acute renal injury. Several clinical trials using renal replacement therapy (RRT) for prevention of CI-AKI yielded conflicting results. We performed a meta-analysis to assess the efficacy of prophylactic RRT on CI-AKI. Methods: Randomized controlled trials on CI-AKI using RRT were identified without language restriction in Cochrane library, Pubmed and Embase. Data extracted from literature were analyzed with Review manager and Stata software. Results: Nine randomized controlled trials involving 751 patients were included. Heterogeneity was found across trials (p < 0.00001). A random effect model was used to combine the data. RRT reduced the risk of CI-AKI by 26% compared with the control group, but statistical significance was not reached (risk ratio (RR) 0.74, 95% CI 0.35–1.60, p = 0.45). Subgroup analysis of modality indicated that hemodialysis was ineffective in reducing the risk of CI-AKI (RR 1.21, 95% CI 0.63–2.32, p = 0.57), while CRRT decreased the incidence of CI-AKI (RR 0.22, 95% CI 0.07–0.64, p = 0.006). Subgroup analysis according to the CKD stage did not record heterogeneity across trials. RRT increased the odds of CI-AKI in CKD stage 3 patients (RR 1.53, 95% CI 0.07–0.64, p = 0.01), but decreased the occurrence of CI-AKI in patients with CKD stage higher than 3 (RR 0.74, 95% CI 0.35–1.60, p = 0.45). The pooled RR of the need for permanent dialysis demonstrated an insignificant trend towards benefit in patients treated with RRT (RR 0.61, 95% CI 0.26–1.40, p = 0.24). RRT reduced in-hospital mortality compared with control group (RR 0.33, 95% CI 0.14–0.77, p = 0.01). Conclusion: RRT fails to reduce the incidence of CI-AKI in CKD stage 3 patients, but may be beneficial in patients with more advanced renal function. CRRT is more effective than hemodialysis for prevention of CI-AKI. RRT is effective in reducing the in-hospital mortality of CI-AKI patients.

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Section: Introductionmentioning

confidence: 99%

Renal Replacement Therapy for Prevention of Contrast-Induced Acute Kidney Injury: A Meta-Analysis of Randomized Controlled Trials

et al. 2010

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“…It has been reported that 60-90 % of the contrast medium is removed during 1 session of hemodialysis. Clinical studies have been conducted on the basis of these findings to investigate the efficacy of hemodialysis, hemodiafiltration, and hemofiltration in the prevention of CIN [160][161][162][163][164][165][166][167][168][169]. However, most studies could not demonstrate the efficacy of these procedures in the prevention of CIN.…”

Section: Level Of Evidence: II Grade Of Recommendation: C2 Rationale mentioning

confidence: 99%

Guidelines on the use of iodinated contrast media in patients with kidney disease 2012: digest version

et al. 2013

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“…121 Several studies explored the prophylactic value of hemodialysis in high risk patients, but most failed to demonstrate a reduced incidence of CI-AKI. 121 On the other hand, Marenzi et al 122 recently found that hemofiltration significantly reduced CI-AKI in patients at high risk. In this study, patients with chronic kidney disease undergoing coronary angiography were randomized to undergo either hemofiltration in an intensive care unit or parenteral saline hydration.…”

Section: (V) Hemodialysis and Hemofiltrationmentioning

confidence: 99%

Cardiological Society of India Practice Guidelines for Angiography in Patients with Renal Dysfunction

Bhandari

Sethi

Tyagi

et al. 2012

Indian Heart Journal

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Preamble: The potential risk of contrast-induced acute kidney injury (CI-AKI) has made utilization of coronary angiography in the work-up for the diagnosis of coronary artery disease in CKD quite low.1 This is in contrast to increasing prevalence and severity of CAD as the serum creatinine rises. 2 In fact most CKD patients will succumb to CAD and not to ESRD. This was presented by SB, and over the next two hours each data subset was debated/ Available online at www.sciencedirect.com journal homepage: w ww.el sevier.com/locate /ihj i n d i a n h e a r t j o u r n a l 6 4 ( 2 0 1 2 ) S 1 8 eS 4 3

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Does Post-angiographic Hemodialysis Reduce the Risk of Contrast-medium Nephropathy?

Cited by 64 publications

References 23 publications

Renal Replacement Therapy for Prevention of Contrast-Induced Acute Kidney Injury: A Meta-Analysis of Randomized Controlled Trials

Renal Replacement Therapy for Prevention of Contrast-Induced Acute Kidney Injury: A Meta-Analysis of Randomized Controlled Trials

Guidelines on the use of iodinated contrast media in patients with kidney disease 2012: digest version

Cardiological Society of India Practice Guidelines for Angiography in Patients with Renal Dysfunction

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