Prophylactic Hemodialysis Does Not Prevent Contrast-Induced Nephropathy After Cardiac Catheterization in Patients With Chronic Renal Insufficiency

Abstract

Background In Japan, prophylactic hemodialysis has been considered useful for preventing contrast-induced nephropathy (CIN). Method and ResultsTo assess whether hemodialysis prevented CIN, 391 patients (age: 69±8 years, 63 females) with chronic renal insufficiency (CRI, serum creatinine level (Scr) ≥1.3 mg/dl) who underwent cardiac catheterization, were retrospectively analyzed. Patients were divided into 3 categories based on Scr: L (1.3 ≤Scr <2.0 mg/dl, n=332); M (2.0 ≤Scr <3.0 mg/dl, n=49); and H (Scr ≥3.0 mg/dl, n=10). To prevent CIN, 35 category M patients and all category L patients received hydration alone, whereas 14 category M patients and all category H patients received hemodialysis. CIN developed in 48 patients. The incidence of CIN in category H was significantly higher than that in category L or M (H, 40% vs L, 11% or M, 16% (p<0.05)). In category M patients treated with hemodialysis, Scr increased from 2.4±0.3 to 3.0±0.5 mg/dl (p<0.05) within 7 days, and 29% of patients developed CIN. However, in category M patients who did not receive hemodialysis, the Scr did not change (pre, 2.3±0.2 mg/dl to post, 2.2±0.4 mg/dl), and the incidence of CIN was 11%. Conclusion Prophylactic hemodialysis for CRI patients undergoing cardiac catheterization does not prevent CIN. (Circ J 2006; 70: 553 -558)

Contrast-induced nephropathy

“…[7576] A study by Lee et al ., showed a protective effect,[77] all other clinical trials did not find any benefit of immediate hemodialysis after exposure to CM in patients with preexisting CKD undergoing angiography. [787980]…”

Protective Effects of Anisodamine on Renal Function in Patients with ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

“…Thus, there is a pressing need to find effective strategies to prevent it (Mautone and Brown 2010). Although several therapeutic approaches have been described to reduce the incidence of CIN, only hydration has been consistently shown to be effective (Kawashima et al 2006;Kowalczyk et al 2007).…”

Incidence of and Risk Factors for Contrast-Induced Nephropathy After Cardiac Catheterization in Japanese Patients

“…8,9 Older age, female gender, anemia, high-dose usage of contrast medium, heart failure, diabetes mellitus and peripheral vascular disease (PVD) are also reported as risk factors that increase the likelihood of CIN. [9][10][11][12] It is still uncertain to what extent these factors independently worsen renal function.The incidence of and risk factors for CIN in Japanese patients are unknown at present, so we retrospectively analyzed a Japanese cohort. …”

“…8 Some studies report that the tolerated dose of contrast medium depends on kidney function, 6 but we opted for the simple definition of high volume of contrast medium ≥200 ml for practical and easier application. 8,12 Statistical Analysis Continuous variables of each group are presented as mean ± standard deviation and the categorical variables are expressed as number and percentage. The potential risk factors for CIN examined in the present study were elderly, female gender, underweight, anemia, preexisting renal insufficiency, high-dose contrast medium, diabetes mellitus (DM), CHF, and PVD.…”