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The prevention of contrast-induced nephropathy by simultaneous hemofiltration during coronary angiographic

Myung-Jin Choi1, Jong-Woo Yoon1, Sang-Jin Han2

  • 1Department of Internal Medicine, College of Medicine, Hallym University, Republic of Korea; Hallym University Kidney Research Institute, Republic of Korea.

International Journal of Cardiology
|September 10, 2014
PubMed

Insights

Simultaneous hemofiltration offers comparable early renal protection against contrast-induced nephropathy (CIN) and superior late-stage protection in chronic kidney disease (CKD) patients undergoing coronary angiography, at a significantly lower cost than periprocedural hemofiltration.

Area of Science:

  • Nephrology
  • Cardiology
  • Intensive Care Medicine

Background:

  • Contrast-induced nephropathy (CIN) is a risk for chronic kidney disease (CKD) patients undergoing coronary angiography.
  • Periprocedural hemofiltration (PHF) prevents CIN but overuses resources and can lead to persistent renal injury.
  • Simultaneous hemofiltration (SHF) during angiography offers a more resource-efficient alternative with immediate renal protection.

Purpose of the Study:

  • To compare the efficacy and cost-effectiveness of simultaneous hemofiltration versus periprocedural hemofiltration in preventing CIN in CKD patients undergoing coronary angiography.

Main Methods:

  • A randomized controlled trial involving 68 CKD patients undergoing coronary angiography.
  • Patients were randomized to receive either periprocedural hemofiltration (n=23) or simultaneous hemofiltration (n=45).
  • Renal function was assessed by serum creatinine levels and CIN incidence at multiple time points post-procedure.

Main Results:

  • Both groups showed similar early CIN rates on day 3 (17.4% vs. 15.6%, p=0.846).
  • Simultaneous hemofiltration demonstrated significantly lower late-stage CIN rates on days 5-30 (6.7% vs. 30.4%, p=0.009).
  • Serum creatinine levels increased in the periprocedural group post-discharge, unlike the simultaneous group. SHF was significantly less costly ($504±40 vs. $1066±83, p<0.001).

Conclusions:

  • Simultaneous hemofiltration provides equivalent early and superior late-stage renal protection against CIN compared to periprocedural hemofiltration.
  • SHF is a more cost-effective strategy for preventing CIN in CKD patients undergoing coronary angiography.
  • SHF mitigates persistent renal injury observed with PHF.
Abstract

Keywords:
Chronic kidney diseaseContrast nephropathyCoronary angiographyHemofiltration

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