Does Continuous Venovenous Hemodiafiltration Concomitant with Radiological Procedures Provide a Significant and Safe Removal of the Iodinated Contrast Ioversol?

Gabutti, Luca; Marone, Claudio; Monti, M.; Malfanti, Marco; Zwahlen, Ugo; Pasotti, Elena; Colucci, Giuseppe; Schönholzer, Carlo

doi:10.1159/000069153

Cited by 26 publications

(9 citation statements)

References 25 publications

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“…Continuous renal replacement therapies (CRRT), hemodiafiltration (CVVHD), and hemofiltration (CVVH) have also been studied [122][123][124]. When CVVHD was initiated immediately before and continued throughout the contrast study, no effect on the incidence of CIN was observed [122].…”

Section: Removal Of Contrast Media By Extracorporeal Therapiesmentioning

confidence: 99%

“…When CVVHD was initiated immediately before and continued throughout the contrast study, no effect on the incidence of CIN was observed [122]. In the first of two CVVH study by Marenzi et al [123], prophylactic hemofiltration was begun 6 h before contrast administration in a high-risk group (serum creatinine 3.0 mg/dl), held up during the angiography procedure, and then resumed following the procedure and continued for 18-24 h [123].…”

Section: Removal Of Contrast Media By Extracorporeal Therapiesmentioning

confidence: 99%

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Contrast-induced nephropathy: pathogenesis and prevention

Cronin

2010

Pediatr Nephrol

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Contrast-induced nephropathy (CIN) is the third most common cause of acute kidney injury in hospitalized patients. Diagnostic and interventional cardiovascular procedures generate nearly half the cases. Elderly patients and those with chronic kidney disease, diabetes, and cardiovascular disease are at greatest risk. Procedure-related risk factors include large volumes of contrast and agents with a high osmolality. Renal medullary ischemia arising from an imbalance of local vasoconstrictive and vasodilatory influences coupled with increased demand for oxygen-driven sodium transport may be the key to its pathogenesis. Contrast agents may also have a direct cytotoxic effect that operates through the generation of reactive oxygen species. Pre- and post-procedure administration of normal saline, isotonic sodium bicarbonate, N-acetylcysteine, and a variety of other pharmacologic agents have been used to prevent or mitigate CIN. While normal saline is generally accepted as protective against CIN, uncertainty still surrounds the role of sodium bicarbonate and N-acetylcysteine. Dialytic therapies before, during, and after exposure to contrast have been tested with mixed results. Logistical and economic disincentives argue against these modalities.

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Section: Removal Of Contrast Media By Extracorporeal Therapiesmentioning

confidence: 99%

Section: Removal Of Contrast Media By Extracorporeal Therapiesmentioning

confidence: 99%

Contrast-induced nephropathy: pathogenesis and prevention

Cronin

2010

Pediatr Nephrol

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“…Amongst those, three studies utilized periprocedural hemodialysis, with variable benefit [258][259][260][261]. Prophylactic CVVH was evaluated in a total of 114 patients at high risk of contrast nephropathy undergoing coronary intervention.…”

Section: Clinical Studiesmentioning

confidence: 99%

Prevention of acute kidney injury and protection of renal function in the intensive care unit

et al. 2009

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Background: Acute renal failure on the intensive care unit is associated with significant mortality and morbidity. Objectives: To determine recommendations for the prevention of acute kidney injury (AKI), focusing on the role of potential preventative maneuvers including volume expansion, diuretics, use of inotropes, vasopressors/vasodilators, hormonal interventions, nutrition, and extracorporeal techniques. Method: A systematic search of the literature was performed for studies using these potential protective agents in adult patients at risk for acute renal failure/kidney injury between 1966 and 2009. The following clinical conditions were considered: major surgery, critical illness, sepsis, shock, and use of potentially nephrotoxic drugs and radiocontrast media. Where possible the following endpoints were extracted: creatinine clearance, glomerular filtration rate, increase in serum creatinine, urine output, and markers of tubular injury. Clinical endpoints included the need for renal replacement therapy, length of stay, and mortality. Studies are graded according to the international Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) group system Conclusions and recommendations: Several measures are recommended, though none carries grade 1A. We recommend prompt resuscitation of the circulation with special attention to providing adequate hydration whilst avoiding high-molecular-weight hydroxy-ethyl starch (HES) preparations, maintaining adequate blood Intensive Care Med (2010) 36:392-411 DOI 10.1007/s00134-009-1678 EXPERT PANEL pressure using vasopressors in vasodilatory shock. We suggest using vasopressors in vasodilatory hypotension, specific vasodilators under strict hemodynamic control, sodium bicarbonate for emergency procedures administering contrast media, and periprocedural hemofiltration in severe chronic renal insufficiency undergoing coronary intervention.

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“…However, this review included two nonrandomized trials [20,21], and heterogeneity was noted across the trials. In the present study, we combined evidence from nine RCTs to obtain current estimate on the effect of RRT for prevention of CI-AKI.…”

Section: Introductionmentioning

confidence: 99%

Renal Replacement Therapy for Prevention of Contrast-Induced Acute Kidney Injury: A Meta-Analysis of Randomized Controlled Trials

et al. 2010

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Background: Contrast-induced acute kidney injury (CI-AKI) is an important cause of acute renal injury. Several clinical trials using renal replacement therapy (RRT) for prevention of CI-AKI yielded conflicting results. We performed a meta-analysis to assess the efficacy of prophylactic RRT on CI-AKI. Methods: Randomized controlled trials on CI-AKI using RRT were identified without language restriction in Cochrane library, Pubmed and Embase. Data extracted from literature were analyzed with Review manager and Stata software. Results: Nine randomized controlled trials involving 751 patients were included. Heterogeneity was found across trials (p < 0.00001). A random effect model was used to combine the data. RRT reduced the risk of CI-AKI by 26% compared with the control group, but statistical significance was not reached (risk ratio (RR) 0.74, 95% CI 0.35–1.60, p = 0.45). Subgroup analysis of modality indicated that hemodialysis was ineffective in reducing the risk of CI-AKI (RR 1.21, 95% CI 0.63–2.32, p = 0.57), while CRRT decreased the incidence of CI-AKI (RR 0.22, 95% CI 0.07–0.64, p = 0.006). Subgroup analysis according to the CKD stage did not record heterogeneity across trials. RRT increased the odds of CI-AKI in CKD stage 3 patients (RR 1.53, 95% CI 0.07–0.64, p = 0.01), but decreased the occurrence of CI-AKI in patients with CKD stage higher than 3 (RR 0.74, 95% CI 0.35–1.60, p = 0.45). The pooled RR of the need for permanent dialysis demonstrated an insignificant trend towards benefit in patients treated with RRT (RR 0.61, 95% CI 0.26–1.40, p = 0.24). RRT reduced in-hospital mortality compared with control group (RR 0.33, 95% CI 0.14–0.77, p = 0.01). Conclusion: RRT fails to reduce the incidence of CI-AKI in CKD stage 3 patients, but may be beneficial in patients with more advanced renal function. CRRT is more effective than hemodialysis for prevention of CI-AKI. RRT is effective in reducing the in-hospital mortality of CI-AKI patients.

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Does Continuous Venovenous Hemodiafiltration Concomitant with Radiological Procedures Provide a Significant and Safe Removal of the Iodinated Contrast Ioversol?

Cited by 26 publications

References 25 publications

Contrast-induced nephropathy: pathogenesis and prevention

Contrast-induced nephropathy: pathogenesis and prevention

Prevention of acute kidney injury and protection of renal function in the intensive care unit

Renal Replacement Therapy for Prevention of Contrast-Induced Acute Kidney Injury: A Meta-Analysis of Randomized Controlled Trials

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