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Effectiveness of high flow‐volume intermittent hemodiafiltration during and after intervention to prevent contrast‐induced nephropathy in patients with advanced chronic kidney disease: A pilot study
Author(s) -
Oyamada Naofumi,
Hamanaka Ichiro,
Fujioka Ayumu,
Iwasaku Toshihiro,
Minami Takeya,
Fujie Hiroaki,
Ueda Kinzo
Publication year - 2020
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.28640
Subject(s) - medicine , kidney disease , hemodialysis , renal function , contrast induced nephropathy , incidence (geometry) , saline , nephropathy , urology , surgery , diabetes mellitus , endocrinology , physics , optics
Objectives We analyzed the effect of high flow‐volume intermittent hemodiafiltration (HF‐IHDF) on patients with advanced chronic kidney disease (CKD) undergoing procedures requiring administration of contrast medium. Background There is no effective method for preventing contrast‐induced nephropathy (CIN), especially in patients with advanced CKD. We established HF‐IHDF as a renal protective therapy with a filtration flow rate up to 5 times greater than standard continuous HDF. In this study, we tested whether HF‐IHDF could prevent CIN in patients with advanced CKD more effectively than saline hydration only. Methods We retrospectively analyzed the incidence of CIN and clinical outcomes up to 1 year after performance of a procedure in 76 patients with advanced CKD. HF‐IHDF was performed from just before the procedure until 2.5 hr after it. Hydration with 0.9% saline was also administered. Results The incidence of CIN was significantly lower in the HF‐IHDF group than the saline group 2–3 days (0%, 0/76 patients vs. 9.3%, 5/54 patients; p < .05) and 1 month (3.9%, 3/76 patients vs. 14.8%, 8/54 patients; p < .05) after intervention. No difference between the two groups was detected in the proportion of patients requiring permanent hemodialysis within 1 year after intervention or the 1 year mortality rate. However, the number of patients free from progression of renal dysfunction after 1 year of follow‐up was significantly higher in the HF‐IHDF group (86.8%, 66/76 patients vs. 64.8%, 35/54 patients; p < .01). Conclusions HF‐IHDF during and after interventional procedure requiring administration of contrast medium may prevent CIN in patients with advanced CKD.