The prevention of radiocontrast-agent-induced XXXX by hemofiltration.

@entity1 @entity8 @entity353 @entity177 @entity1011
BACKGROUND: @entity8 induced by exposure to radiocontrast agents, a possible complication of percutaneous coronary interventions, is associated with significant in-hospital and long-term morbidity and mortality. @entity1 with preexisting @entity177 are at particularly high risk. We investigated the role of hemofiltration, as compared with isotonic-saline hydration, in preventing contrast-agent-induced @entity8 in @entity1 with @entity177 . METHODS: We studied 114 consecutive @entity1 with @entity177 (serum @entity1011 concentration, >2 mg per deciliter [176.8 micromol per liter]) who were undergoing coronary interventions. We randomly assigned them to either hemofiltration in an intensive care unit (ICU) (58 @entity1 , with a mean [+/-SD] serum @entity1011 concentration of 3.0+/-1.0 mg per deciliter [265.2+/-88.4 micromol per liter]) or isotonic-saline hydration at a rate of 1 ml per kilogram of body weight per hour given in a step-down unit (56 @entity1 , with a mean serum @entity1011 concentration of 3.1+/-1.0 mg per deciliter [274.0+/-88.4 micromol per liter]). Hemofiltration (fluid replacement rate, 1000 ml per hour without @entity353 ) and saline hydration were initiated 4 to 8 hours before the coronary intervention and were continued for 18 to 24 hours after the procedure was completed. RESULTS: An increase in the serum @entity1011 concentration of more than 25 percent from the base-line value after the coronary intervention occurred less frequently among the @entity1 in the hemofiltration group than among the control @entity1 (5 percent vs. 50 percent, P<0.001). Temporary renal-replacement therapy (hemodialysis or hemofiltration) was required in 25 percent of the control @entity1 and in 3 percent of the @entity1 in the hemofiltration group. The rate of in-hospital events was 9 percent in the hemofiltration group and 52 percent in the control group (P<0.001). In-hospital mortality was 2 percent in the hemofiltration group and 14 percent in the control group (P=0.02), and the cumulative one-year mortality was 10 percent and 30 percent, respectively (P=0.01). CONCLUSIONS: In @entity1 with @entity177 who are undergoing percutaneous coronary interventions, periprocedural hemofiltration given in an ICU setting appears to be effective in preventing the deterioration of renal function due to contrast-agent-induced @entity8 and is associated with improved in-hospital and long-term outcomes.
