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CLINICAL RESEARCH: CLINICAL TRIAL

Renal Protection for Coronary Angiography in Advanced Renal Failure Patients by Prophylactic Hemodialysis

A Randomized Controlled Trial

Po-Tsang Lee, MD^_*,,, Kang-Ju Chou, MD^_*,, Chun-Peng Liu, MD, Guang-Yuan Mar, MD, Chien-Liang Chen, MD^_*,, Chih-Yang Hsu, MD^_*, Hua-Chang Fang, MD^_*,,_* and Hsiao-Min Chung, MD^_*

^_* Division of Nephrology, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
Division of Cardiology, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
National Yang-Ming University, School of Medicine, Taipei, Taiwan
Institute of Clinical Medicine, National Cheng Kung University Medical College, Tainan, Taiwan.

Manuscript received December 6, 2006; revised manuscript received May 18, 2007, accepted May 22, 2007.

^_* Reprint requests and correspondence to: Dr. Hua-Chang Fang, Division of Nephrology, Kaohsiung Veterans General Hospital, 386 Ta-Chung First Rd, Kaohsiung, Taiwan 813. (Email: hcfang{at}isca.vghks.gov.tw).

Objectives: 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 m² vs. 2.2 ± 2.8 ml/min/1.73 m²; 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.

Abbreviations and Acronyms   CAG = coronary angiography   CN = contrast nephropathy   Cr = serum creatinine   CrCl = creatinine clearance   ESRD = end-stage renal disease

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