title: The prevention of contrast-induced nephropathy by simultaneous hemofiltration during coronary angiographic procedures: a comparison with periprocedural hemofiltration.
abstract: BACKGROUND
  Periprocedural (6 h pre- and 24 h post-angiography) hemofiltration appears to effectively prevent contrast-induced nephropathy (CIN) in chronic kidney disease (CKD) patients undergoing coronary angiography. However, this procedure over-uses medical resources, and the cessation of hemofiltration during coronary angiography results in persistent renal injury. In comparison, simultaneous hemofiltration performed only during coronary angiography requires fewer medical resources and can provide instantaneous protection against CIN.
  
  
  METHODS
  Sixty-eight CKD patients (serum creatinine, 2.51±1.15 mg/dL) undergoing coronary angiography were randomized in a 1:2 ratio to receive either periprocedural (n=23) or simultaneous (n=45) hemofiltration. The expected CIN rate was similar for the two groups (41.3% versus 40.0%, p=0.769).
  
  
  RESULTS
  On day 3 after contrast exposure, four and seven patients in the periprocedural and simultaneous groups, respectively experienced CIN (17.4% versus 15.6%, p=0.846). On days 5-30, seven and three patients in the periprocedural and simultaneous groups, respectively experienced CIN (30.4% versus 6.7%, p=0.009). The serum creatinine levels of patients in the periprocedural group transiently decreased on day 1 and persistently increased during days 5-30 compared with the simultaneous group. This difference between the two groups in terms of creatinine levels over time was statistically significant (F statistic=6.830; p=0.001, by ANCOVA). The cost of hemofiltration was doubled in the periprocedural group ($1066±83 versus $504±40, p<0.001).
  
  
  CONCLUSIONS
  Simultaneous hemofiltration provide equal early (day 3) and better late-stage (days 5-30) renal protection against CIN at a significantly lower cost compared with periprocedural hemofiltration.
authors.affiliation: Department of Internal Medicine, College of Medicine, Hallym University, Republic of Korea; Hallym University Kidney Research Institute, Republic of Korea.
authors.forename: Myung-Jin
authors.initials: MJ
authors.lastname: Choi
authors.affiliation: Department of Internal Medicine, College of Medicine, Hallym University, Republic of Korea; Hallym University Kidney Research Institute, Republic of Korea.
authors.forename: Jong-Woo
authors.initials: JW
authors.lastname: Yoon
authors.affiliation: Department of Internal Medicine, College of Medicine, Hallym University, Republic of Korea.
authors.forename: Sang-Jin
authors.initials: SJ
authors.lastname: Han
authors.affiliation: Department of Internal Medicine, College of Medicine, Hallym University, Republic of Korea.
authors.forename: Hyun-Hee
authors.initials: HH
authors.lastname: Choi
authors.affiliation: Department of Internal Medicine, College of Medicine, Hallym University, Republic of Korea; Hallym University Kidney Research Institute, Republic of Korea.
authors.forename: Young-Rim
authors.initials: YR
authors.lastname: Song
authors.affiliation: Department of Internal Medicine, College of Medicine, Hallym University, Republic of Korea; Hallym University Kidney Research Institute, Republic of Korea.
authors.forename: Sung-Gyun
authors.initials: SG
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, College of Medicine, Hallym University, Republic of Korea; Hallym University Kidney Research Institute, Republic of Korea.
authors.forename: Ji-Eun
authors.initials: JE
authors.lastname: Oh
authors.affiliation: Department of Internal Medicine, College of Medicine, Hallym University, Republic of Korea; Hallym University Kidney Research Institute, Republic of Korea.
authors.forename: Young-Ki
authors.initials: YK
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, College of Medicine, Hallym University, Republic of Korea; Hallym University Kidney Research Institute, Republic of Korea; Division of Nephrology, Dongtan Sacred Heart Hospital, Hallym University Medical Center, Republic of Korea.
authors.forename: Jang-Won
authors.initials: JW
authors.lastname: Seo
authors.affiliation: Department of Internal Medicine, College of Medicine, Hallym University, Republic of Korea; Hallym University Kidney Research Institute, Republic of Korea.
authors.forename: Hyung-Jik
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, College of Medicine, Hallym University, Republic of Korea; Hallym University Kidney Research Institute, Republic of Korea.
authors.forename: Jung-Woo
authors.initials: JW
authors.lastname: Noh
authors.affiliation: Department of Internal Medicine, College of Medicine, Hallym University, Republic of Korea; Hallym University Kidney Research Institute, Republic of Korea; Division of Nephrology, Dongtan Sacred Heart Hospital, Hallym University Medical Center, Republic of Korea. Electronic address: jrkoo@hallym.ac.kr.
authors.forename: Ja-Ryong
authors.initials: JR
authors.lastname: Koo
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000453:epidemiology / Q000517:prevention & control*; D000368:Aged; D003287:Contrast Media / Q000009:adverse effects*; D017023:Coronary Angiography / Q000009:adverse effects* / Q000379:methods; D003404:Creatinine / Q000097:blood; D005260:Female; D006440:Hemofiltration / Q000379:methods*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods; D010865:Pilot Projects; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000150:complications / Q000000981:diagnostic imaging*; D014283:Triiodobenzoic Acids / Q000009:adverse effects
chemical_list: D003287:Contrast Media; D014283:Triiodobenzoic Acids; D003404:Creatinine; C044834:iodixanol
keywords: Chronic kidney disease; Contrast nephropathy; Coronary angiography; Hemofiltration