Prophylactic hemodialysis after radiocontrast media in patients with renal insufficiency is potentially harmful

Contrast induced nephropathy (CIN) is an iatrogenic disorder, resulting from exposure to contrast media. Contrast-induced hemodynamic and direct cytotoxic effects on renal structures are highly evident in its pathogenesis, whereas other mechanisms are still poorly understood. CIN is typically defined as an increase in serum creatinine by either 0.5 mg/dl or by 25% from baseline within the first 2-3 days after contrast administration. Although rare in the general population, CIN has a high incidence in patients with an underlying renal disorder, in diabetics, and the elderly. The risk factors are synergistic in their ability to produce CIN. The best way to prevent CIN is to identify the patients at risk and to provide adequate peri-procedural hydration. The role of various drugs in prevention of CIN is still controversial and warrants future studies. Despite remaining uncertainty regarding the degree of nephrotoxicity produced by various contrast agents, in current practice non-ionic low-osmolar contrast media are preferred over the high-osmolar contrast media in patients with renal impairment.

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“…All these studies provided consistent results, showing that prophylactic hemodialysis does not diminish the rates of CIN [92,93].…”

Section: Hemodialysis and Hemofiltrationmentioning

confidence: 54%

Contrast‐induced nephropathy

Pučelíková

Dangas

Mehran

2007

Cathet Cardio Intervent

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“…In brief, prophylactic hemodialysis appeared to be an ineffective and even harmful strategy for the prevention of CIN in patients with chronic kidney disease who are undergoing coronary angiography (8), as found by previous smaller studies (12,14,17). Moreover, predictors of CIN and the impact of a contrast mediainduced decrease in renal function on long-term mortality were prospectively assessed in our DVD trial.…”

Section: Discussionmentioning

confidence: 68%

“…The glomerular filtration rate (GFR) was estimated using the Modification of Diet in Renal Disease equation (11) In accordance with other studies (1,3,4,9,(12)(13)(14)(15)(16)(17), CIN was defined as an increase in serum creatinine of 44.2 μmol/L (0.5 mg/dL) or more within 72 h after the administration of the contrast agent. Creatinine levels at 30 days, which were 44.2 μmol/L or more above the baseline creatinine level before heart catheterization, were classified as elevated creatinine levels at 30 days.…”

Section: Definitionsmentioning

confidence: 99%

Predictors for contrast media-induced nephropathy and long-term survival: Prospectively assessed data from the randomized controlled Dialysis-Versus-Diuresis (DVD) trial

Hölscher¹,

Heitmeyer²,

Fobker³

et al. 2008

Canadian Journal of Cardiology

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T he development of radiographic contrast media originated from the use of sodium iodide in radiography in 1918 (1), when Walter Dandy directly injected contrast media into the cerebral ventricles for visualizing the outline of the brain and the ventricular system. Since then, many different types of contrast media have been synthesized, and many improvements in terms of side effects, such as hypersensitivity reactions, have been made. Moreover, associated acute renal failure, currently classified as contrast media-induced nephropathy (CIN), remains a major complication in hospitalized patients undergoing diagnostic or therapeutic interventional procedures using CLINICAL STUDIES ©2008 Pulsus Group Inc. All rights reserved BACKGROUND: Among the numerous studies concerning contrast media-induced nephropathy (CIN), there was no prospective trial that provided data on the long-term outcomes. OBJECTIVES: To prospectively assess predictors of CIN and long-term outcomes of affected patients. METHODS: Four hundred twelve consecutive patients with serum creatinine levels of 115 μmol/L to 309 μmol/L (1.3 mg/dL to 3.5 mg/dL) undergoing elective coronary angiography were included. Patients were randomly assigned to periprocedural hydration alone, hydration plus onetime hemodialysis or hydration plus N-acetylcysteine. RESULTS: Multivariate logistic regression identified the following as predictors of CIN within 72 h (equivalent to an increase in creatinine 44.2 μmol/L [0.5 mg/dL] or more) : prophylactic postprocedural hemodialysis (OR 2.86, 95% CI 1.07 to 7.69), use of angiotensin-converting enzyme inhibitors (OR 6.16, 95% CI 2.01 to 18.93), baseline glomerular filtration rate (OR 0.94, 95% CI 0.90 to 0.98) and the amount of contrast media given (OR 1.01, 95% CI 1.00 to 1.01). With regard to long-term outcome (mean follow-up 649 days), multivariate Cox regression models found elevated creatinine levels at 30 days (hazard rate ratio [HRR] 5.48, 95% CI 2.85 to 10.53), but not CIN within 72 h (HRR 1.12, 95% CI 0.63 to 2.02), to be associated with increased mortality. In addition, independent predictors for death during follow-up included left ventricular ejection fraction lower than 35% (HRR 4.01, 95% CI 2.22 to 7.26), serum phosphate (HRR 1.64, 95% CI 1.10 to 2.43) and hemoglobin (HRR 0.80, 95% CI 0.67 to 0.96). CONCLUSION: From the present prospective trial, performance of postprocedural hemodialysis, use of angiotensin-converting enzyme inhibitors, reduced baseline glomerular filtration rate and amount of contrast media were independent predictors of CIN within 72 h after catheterization. Assessing renal function after 30 days, rather than within 72 h, seemed to be more predictive for patients' long-term survival.

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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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Prophylactic hemodialysis after radiocontrast media in patients with renal insufficiency is potentially harmful

Cited by 254 publications

References 23 publications

Contrast‐induced nephropathy

Contrast‐induced nephropathy

Predictors for contrast media-induced nephropathy and long-term survival: Prospectively assessed data from the randomized controlled Dialysis-Versus-Diuresis (DVD) trial

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

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