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Effects of two different treatments with continuous renal replacement therapy in patients with chronic renal

Valentina Spini1, Emanuele Cecchi, Marco Chiostri

  • 1Azienda Ospedaliero-Universitaria Careggi, Department of Heart and Vessels, viale Morgagni 85, Florence, Italy.

The Journal of Invasive Cardiology
|February 8, 2013
PubMed

Insights

For patients with chronic kidney disease undergoing percutaneous coronary intervention, performing continuous renal replacement therapy (CRRT) both before and after the procedure, compared to only after, significantly reduces kidney function decline and improves long-term survival.

Area of Science:

  • Nephrology
  • Cardiology
  • Intensive Care Medicine

Background:

  • Percutaneous coronary intervention (PCI) carries a risk of contrast-induced nephropathy (CIN), particularly in patients with chronic kidney disease (CKD).
  • Identifying optimal strategies to mitigate CIN risk in CKD patients undergoing PCI is crucial for improving patient outcomes.

Purpose of the Study:

  • To evaluate the efficacy of continuous renal replacement therapy (CRRT) initiated before and after PCI versus CRRT performed only after PCI in CKD patients.
  • To assess the impact of these CRRT strategies on renal function and long-term patient survival.

Main Methods:

  • A study of 46 CKD patients undergoing PCI, divided into two groups: CRRT only after PCI (CRRTpost, n=21) and CRRT before and after PCI (CRRTpre-post, n=25).
  • CRRT modalities (hemofiltration or hemodiafiltration) were selected based on baseline creatinine levels.
  • CRRTpre-post group received therapy 6-8 hours before PCI and re-initiated immediately after for 18-24 hours.

Main Results:

  • The CRRTpre-post group demonstrated a significantly greater reduction in creatinine levels compared to the CRRTpost group (P=.002).
  • At a median 14.7-month follow-up, CKD progression occurred in 12% of CRRTpre-post patients versus 43% of CRRTpost patients (P=.042).
  • Kaplan-Meier analysis revealed significantly higher overall mortality (P=.041) and increased cardiovascular deaths in the CRRTpre-post group during follow-up.

Conclusions:

  • Performing CRRT before and after PCI in CKD patients is more effective in preventing further renal function deterioration compared to CRRT performed only after PCI.
  • This pre- and post-PCI CRRT strategy is associated with improved long-term outcomes, including reduced mortality, in this high-risk patient population.
Abstract

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