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The prevention of radiocontrast-agent-induced nephropathy by hemofiltration.
Marenzi G, Marana I, Lauri G, Assanelli E, Grazi M, Campodonico J, Trabattoni D, Fabbiocchi F, Montorsi P, Bartorelli AL
N Engl J Med 2003 Oct 2;349(14):1333-40.
abstract (from PubMed)


Background

Currently available methods for preventing contrast-induced nephropathy have not been shown to have clinical benefits in patients with significant pre-existing renal disease, nor has hemodialysis started immediately after exposure to contrast agents. In this study, the authors looked at hemofiltration (rather than dialysis) started 4-8 hours before contrast administration, in patients with renal impairment.

Methods

114 patients with chronic renal failure (creatinine greater than 2.0 mg/dl), scheduled to undergo coronary angiography and/or angioplasty, were randomized to either:

Results

Baseline serum creatinine was 3.1, creatinine clearance 26 ml/min. Average age was 69, prevalence of diabetes 30%, LV EF 50%, prevalence of patients with EF<40 was 25%.

Volume of contrast agent used: 247 ml in hemofiltration group, 258 in control group.



Comments

Subset of patients with higher creatinine derived most of the benefits

October 8, 2003

In terms of one-year mortality, almost all of the benefit from hemofiltration is limited to patients whose initial serum creatinine was over 4.0 mg/dl. Presumably this also would hold for the other benefits (need for in-hospital hemodialysis, for example). Unfortunately, the authors do not describe how the other parameters they followed (renal function and in-hospital mortality) vary with this subgrouping. Also, they do not indicate what percentage of their patients were in this category.

If, indeed, most of the benefit is limited to patients with serum creatinine over 4.0, this could greatly reduce the number of patients who need this rather intensive approach. Perhaps more detail on this subgroup will be published elsewhere.

posted on 2003-10-08 09:53:01 by
Michael Jacobson, MD, MPH
(mjmd)





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