title: Renal protection for coronary angiography in advanced renal failure patients by prophylactic hemodialysis. A randomized controlled trial.
abstract: OBJECTIVE
  We performed a study to determine whether prophylactic hemodialysis reduces contrast nephropathy (CN) after coronary angiography in advanced renal failure patients.
  
  
  BACKGROUND
  Pre-existing renal failure is the greatest risk factor for CN. Hemodialysis can effectively remove contrast media, but its effect upon preventing CN is still uncertain.
  
  
  METHODS
  Eighty-two patients with chronic renal failure, referred for coronary angiography, were assigned randomly to receive either normal saline intravenously and prophylactic hemodialysis (dialysis group; n = 42) or fluid supplement only (control group; n = 40).
  
  
  RESULTS
  Prophylactic hemodialysis lessened the decrease in creatinine clearance within 72 h in the dialysis group (0.4 +/- 0.9 ml/min/1.73 m(2) vs. 2.2 +/- 2.8 ml/min/1.73 m(2); p < 0.001). Compared with the dialysis group, the serum creatinine concentrations in the control group were significantly higher at day 4 (6.3 +/- 2.3 mg/dl vs. 5.1 +/- 1.3 mg/dl; p = 0.010) and at peak level (6.7 +/- 2.7 mg/dl vs. 5.3 +/- 1.5 mg/dl; p = 0.005). Temporary renal replacement therapy was required in 35% of the control patients and in 2% of the dialysis group (p < 0.001). Thirteen percent of the control patients, but none of the dialysis patients, required long-term dialysis after discharge (p = 0.018). For the patients not requiring chronic dialysis, 13 patients in the control group (37%) and 2 in the dialysis group (5%) had an increase in serum creatinine concentration at discharge of more than 1 mg/dl from baseline (p < 0.001).
  
  
  CONCLUSIONS
  Prophylactic hemodialysis is effective in improving renal outcome in chronic renal failure patients undergoing coronary angiography.
authors.affiliation: Division of Nephrology, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
authors.forename: Po-Tsang
authors.initials: PT
authors.lastname: Lee
authors.forename: Kang-Ju
authors.initials: KJ
authors.lastname: Chou
authors.forename: Chun-Peng
authors.initials: CP
authors.lastname: Liu
authors.forename: Guang-Yuan
authors.initials: GY
authors.lastname: Mar
authors.forename: Chien-Liang
authors.initials: CL
authors.lastname: Chen
authors.forename: Chih-Yang
authors.initials: CY
authors.lastname: Hsu
authors.forename: Hua-Chang
authors.initials: HC
authors.lastname: Fang
authors.forename: Hsiao-Min
authors.initials: HM
authors.lastname: Chung
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000378:metabolism / Q000517:prevention & control*; D000368:Aged; D003287:Contrast Media / Q000009:adverse effects*; D017023:Coronary Angiography / Q000009:adverse effects; D003404:Creatinine / Q000378:metabolism; D005260:Female; D006801:Humans; D007472:Iohexol / Q000009:adverse effects*; D007676:Kidney Failure, Chronic / Q000000981:diagnostic imaging* / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis; D016896:Treatment Outcome