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[The effect of coronary intervention on renal function in patients with chronic renal failure]
Y Nakagawa1, S Fujimoto, C Hara
1First Department of Internal Medicine, Nara Medical University, Japan.
Insights
Coronary intervention in patients with chronic renal failure (CRF) is safe. Adequate hydration and hemodialysis can mitigate adverse effects on renal function, even with higher contrast volumes.
Area of Science:
- Cardiology
- Nephrology
- Interventional Cardiology
Background:
- Patients with chronic renal failure (CRF) undergoing coronary interventions face risks to renal function.
- Assessing the impact of coronary interventions on renal function in CRF patients is crucial.
Purpose of the Study:
- To investigate the effect of coronary intervention on renal function in patients with chronic renal failure (CRF).
Main Methods:
- 19 CRF patients (serum creatinine > 1.5 mg/dl) undergoing coronary intervention were studied.
- Serum creatinine levels were monitored at admission, peak, and discharge.
- Patients were grouped based on serum creatinine increase (delta Scr) post-intervention.
Main Results:
- A worsened group (delta Scr ≥ 1 mg/dl) had significantly higher contrast medium volume (420 ml) vs. unchanged group (253 ml).
- A positive correlation existed between delta Scr and contrast medium volume (r=0.42).
- Renal function mostly recovered with hydration or hemodialysis in the worsened group.
Conclusions:
- Coronary intervention can be safely performed in CRF patients.
- Adequate hydration and hemodialysis are key to managing renal function during these procedures.
- The procedure is feasible even with serum creatinine levels up to 4.0 mg/ml.
Abstract:
To investigate the effect of coronary intervention on renal function in patients with chronic renal failure (CRF) we investigated 19 patients with CRF [serum creatinine (Scr) > 1.5 mg/dl] who underwent coronary intervention for the treatment of acute myocardial infarction or unstable angina recruited from 516 consecutive patients admitted to the coronary care unit of Nara Medical University Hospital from January, 1992 to July, 1995. Serum creatinine levels were measured at 3 points: on admission, at peak level, and at discharge. Nineteen patients were divided into two groups on the basis of increases in Scr (delta Scr): a worsened group (group A) (delta Scr > or = 1mg/dl after coronary intervention; 6 patients) and an unchanged group (group B) (delta Scr < 1 mg/dl ; 13 patients). In group A, except for one patient, the renal function recovered to the level before coronary intervention after adequate hydration or hemodialysis. The volume of contrast medium in group A (420 +/- 134 ml) was significantly higher than group B (253 +/- 97 ml) (p < 0.01). There was significant positive correlation (r = 0.42, p < 0.05) between delta Scr and the volume of contrast medium. In conclusion, coronary intervention for patients with CRF can be performed safely under treatment with adequate hydration and hemodialysis, even at higher serum creatinine levels of up to 4.0 mg/ml.