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

Marenzi, Giancarlo; Mazzotta, Gianfranco; Lotti, Francesco; Gistri, Roberto; Moltrasio, Marco; Cabiati, Angelo; Assanelli, Emilio; Veglia, Fabrizio; Rombolà, Giuseppe

doi:10.1002/ccd.25694

Cited by 6 publications

(4 citation statements)

References 29 publications

(43 reference statements)

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“…Prophylactic RRT in 3 out of 5 studies was HD, 22 - 24 and the other 2 studies were hemofiltration. 25 , 26 Only 3 studies showed the association between decreasing 1-year mortality rate and prophylactic RRT. 24 - 26 While the study by Hsieh et al 23 showed no significant benefit of prophylactic RRT in 1-year mortality.…”

Section: Resultsmentioning

confidence: 99%

“…The volume of contrast media is one of the most important contributing factors for CA-AKI in patients with CKD. Marenzi et al 25 , 26 demonstrated significant renal outcomes and 1-year mortality benefits of prophylactic periprocedural hemofiltration in 2003 and 2015. The studies were conducted in advanced CKD patients (creatinine level >2 mg/dL 26 and estimated glomerular filtration rate ≤30 mL/min/1.73 m 2 ) 25 who were exposed to a high volume of contrast agent (mean contrast volume >200 mL).…”

Section: Discussionmentioning

confidence: 99%

“…Marenzi et al 25 , 26 demonstrated significant renal outcomes and 1-year mortality benefits of prophylactic periprocedural hemofiltration in 2003 and 2015. The studies were conducted in advanced CKD patients (creatinine level >2 mg/dL 26 and estimated glomerular filtration rate ≤30 mL/min/1.73 m 2 ) 25 who were exposed to a high volume of contrast agent (mean contrast volume >200 mL). Thus, significant benefits could be more noticeable in studies performed on patients undergoing complex coronary intervention requiring high contrast volume.…”

Section: Discussionmentioning

confidence: 99%

“…Two studies in our meta-analysis used hemofiltration as RRT and showed significant 1-year mortality benefits compared to the control group. 25 , 26 Song et al 34 demonstrated that continuous RRT is more effective than HD in preventing CA-AKI. Hemofiltration has some limitations, including increased hospital costs and close monitoring in the intensive care unit.…”

Section: Discussionmentioning

confidence: 99%

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Meta-Analysis of Prophylactic Renal Replacement Therapy after Cardiac Catheterization in Patients with Chronic Kidney Disease

Temtanakitpaisan

2023

Anatol J Cardiol

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Background: The benefits of prophylactic renal replacement therapy after cardiac catheterization in patients with chronic kidney disease remain unclear. The aim of this study is to confirm the benefit of prophylactic renal replacement therapy after cardiac catheterization. Methods: We systematically searched for studies published from inception to December 2022 examining the benefits of prophylactic renal replacement therapy after cardiac catheterization in MEDLINE and EMBASE. Data analysis was performed according to the PRISMA statement using the Mantel–Haenszel method. Results: Five studies met the inclusion criteria, which comprised of 532 chronic kidney disease patients who underwent coronary angiography (268 had prophylactic renal replacement therapy and 264 did not have prophylactic renal replacement therapy). The pooled analysis revealed a non-significant decreased risk of 1-year mortality in chronic kidney disease patients who underwent coronary angiography and prophylactic renal replacement therapy compared to those who did not have prophylactic renal replacement therapy (RR = 0.59; P = . 18; CI: 0.28-1.2795, I 2 = 60.4%). The risk of hemodialysis during hospitalization and renal replacement therapy requirement in 1 year in chronic kidney disease patients who underwent coronary angiography and prophylactic renal replacement therapy were lower than in those who did not have prophylactic renal replacement therapy (RR = 0.13; P = . 001; CI: 0.04-0.43, I 2 = 9.1% and RR = 0.29; P = . 015; CI: 0.11-0.78, I 2 = 49.9%, respectively). The sensitivity analysis demonstrated that the overall findings remained consistent and did not significantly alter. Conclusions: Prophylactic renal replacement therapy did not seem to lower 1-year mortality among chronic kidney disease patients who underwent coronary angiography. However, prophylactic renal replacement therapy appeared to reduce the risk of hemodialysis during hospitalization and renal replacement therapy requirement in 1 year.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Meta-Analysis of Prophylactic Renal Replacement Therapy after Cardiac Catheterization in Patients with Chronic Kidney Disease

Temtanakitpaisan

2023

Anatol J Cardiol

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Peri-angiography Hemofiltration to Reduce Mortality

Marenzi

Cosentino

Bartorelli

2016

Reducing Mortality in Acute Kidney Injury

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How to balance risks and benefits in the management of CKD patients with coronary artery disease

2015

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Chronic kidney disease (CKD) is associated with a high burden of coronary artery disease (CAD), which remains the most common cause of morbidity and mortality in CKD patients. Although the management of CAD is more challenging in patients with CKD than in the general population, and coupled with concerns about further deterioration of renal function and therapy-related toxic effects, CKD patients and those receiving dialysis have not traditionally been included in randomized trials evaluating either medical or revascularization therapies. Thus, only scant data from small prospective studies or retrospective analyses of controlled trials and registries are available, and to date no optimal treatment approach has been defined for this subgroup of patients. However, they potentially have much to gain from the pharmacological, interventional, and surgical strategies used in the general population. Thus, the objective of this review is to summarize the current evidence regarding the management of CAD in CKD patients, in particular with respect to uncertainties regarding coronary revascularization options, and their risk-benefit relationship in such a high-risk population.

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

Abstract: Our pilot study suggests that, in ACS patients with severe renal and cardiac insufficiency, treatment with an aggressive prophylactic hemodiafiltration session after urgent or emergency coronary angiography seems to be associated with a relevant improvement in survival.

Cited by 6 publications

References 29 publications

Meta-Analysis of Prophylactic Renal Replacement Therapy after Cardiac Catheterization in Patients with Chronic Kidney Disease

Meta-Analysis of Prophylactic Renal Replacement Therapy after Cardiac Catheterization in Patients with Chronic Kidney Disease

Peri-angiography Hemofiltration to Reduce Mortality

How to balance risks and benefits in the management of CKD patients with coronary artery disease

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