title: Continuous venovenous hemofiltration after coronary procedures for the prevention of contrast-induced acute kidney injury in patients with severe chronic renal failure.
abstract: Continuous venovenous hemofiltration (CVVH) is a renal replacement therapy that has been successfully used in patients with severe chronic renal failure to prevent contrast-induced acute kidney injury (CI-AKI). In this study, we present a consecutive experience using a new CVVH protocol that has also been applied to patients with acute coronary syndrome (ACS). CVVH was performed in consecutive patients with estimated glomerular filtration rate <30 ml/min/1.73 m(2) (mean ± SD, 21.1 ± 7.3 ml/min/1.73 m(2)) undergoing diagnostic or interventional coronary procedures starting after the angiographic procedures. Iopamidol was used as a contrast agent. In the first 6 patients, iopamidol removal by the CVVH hemofilter and kidney was calculated by measuring iopamidol concentrations in the blood, urine, and ultrafiltrate collected during the 6-hour CVVH session. In the second phase, the protocol was applied to 47 additional patients meeting the inclusion criteria. Six-hour CVVH resulted in iopamidol removal comparable with that of 12-hour diuresis (43 ± 12% vs 42 ± 15% of administered, p = NS). CI-AKI occurred in 7.5% of patients in the whole population and no patients had acute pulmonary edema, need for dialysis, or any major bleeding. In conclusion, in a population including patients with ACS with severe chronic renal failure undergoing coronary angiographic procedures, 6-hour CVVH performed only after contrast medium exposure was able to remove an amount of contrast medium similar to that removed by the kidneys in 12 hours and resulted in a low rate of CI-AKI.
authors: Nephrology Unit, Ospedale Civile di Legnano, Legnano (Milan), Italy. Electronic address: carlo.guastoni@ao-legnano.it.
authors: Carlo
authors: C
authors: Guastoni
authors: Nephrology Unit, Ospedale Civile di Legnano, Legnano (Milan), Italy.
authors: Nicoletta
authors: N
authors: Bellotti
authors: Cardiology Unit, Ospedale Civile di Legnano, Legnano (Milan), Italy.
authors: Fabrizio
authors: F
authors: Poletti
authors: Nephrology Unit, Ospedale Civile di Legnano, Legnano (Milan), Italy.
authors: Patrizia
authors: P
authors: Covella
authors: Nephrology Unit, Ospedale Civile di Legnano, Legnano (Milan), Italy.
authors: Barbara
authors: B
authors: Gidaro
authors: Nephrology Unit, Ospedale Civile di Legnano, Legnano (Milan), Italy.
authors: Antonella
authors: A
authors: Stasi
authors: Cardiology Unit, Ospedale Civile di Legnano, Legnano (Milan), Italy.
authors: Giovanni
authors: G
authors: Seveso
authors: Cardiology Unit, Ospedale Civile di Legnano, Legnano (Milan), Italy.
authors: Maurizio
authors: M
authors: D'Urbano
authors: Cardiology Unit, Ospedale Civile di Legnano, Legnano (Milan), Italy.
authors: Matteo
authors: M
authors: Mariani
authors: Cardiology Unit, Ospedale Civile di Legnano, Legnano (Milan), Italy.
authors: Stefano
authors: S
authors: De Servi
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging; D058186:Acute Kidney Injury / Q000139:chemically induced / Q000517:prevention & control*; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media / Q000009:adverse effects*; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000000981:diagnostic imaging; D005260:Female; D005919:Glomerular Filtration Rate; D006440:Hemofiltration / Q000379:methods*; D006801:Humans; D007479:Iopamidol / Q000009:adverse effects*; D007676:Kidney Failure, Chronic / Q000139:chemically induced / Q000517:prevention & control*; D008297:Male
chemical_list: D003287:Contrast Media; D007479:Iopamidol