Document Detail


Continuous Venovenous Hemofiltration After Coronary Procedures for the Prevention of Contrast-Induced Acute Kidney Injury in Patients With Severe Chronic Renal Failure.
MedLine Citation:
PMID:  24321895     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
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:
Carlo Guastoni; Nicoletta Bellotti; Fabrizio Poletti; Patrizia Covella; Barbara Gidaro; Antonella Stasi; Giovanni Seveso; Maurizio D'Urbano; Matteo Mariani; Stefano De Servi
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-11-22
Journal Detail:
Title:  The American journal of cardiology     Volume:  -     ISSN:  1879-1913     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2013 Nov 
Date Detail:
Created Date:  2013-12-10     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2013 Elsevier Inc. All rights reserved.
Affiliation:
Nephrology Unit, Ospedale Civile di Legnano, Legnano (Milan), Italy. Electronic address: carlo.guastoni@ao-legnano.it.
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