Effect of a Contrast Agent on Long-Term Renal Function and the Efficacy of Prophylactic Hemodiafiltration

Abstract

he incidence of hypertension (HT) and of diabetes mellitus (DM) has been continuously increasing with the aging of society and changes in lifestyle. HT and DM can be factors in cardiac and vascular disorders, and chronic renal insufficiency (CRI), so the probability of encountering coronary artery disease in a patient with CRI is relatively high. Contrast-induced nephropathy (CIN) is defined as acute renal dysfunction manifesting as temporary elevated serum creatinine level (Scr) because of the use of a contrast agent, with no other causes, and is reversible with sufficient fluid infusion in most cases. However, there may be an irreversible disturbance. The elevation of Scr in CIN is 0.3-1.0 mg/dl or more, or by 20-50% from the previous level. 1 Recently it has become clear that renal function is an independent prognostic factor of cardiovascular diseases. 2,3 The efficacy of hemofiltration (HF) after using a contrast agent has also been indicated. However, it has been reported that hemodialysis (HD) after the administration of a contrast agent does not completely prevent complications such as CIN,5 and that CIN could not be prevented even when the area under curve of the level of contrast agent concentration decreased. 6 Contrast nephrotoxicity is believed to b temporary and furthermore, the effect on renal function over the long term is unknown. Therefore, the Circulation Journal Vol.72, March 2008effect of a contrast agent on long-term renal function was studied. Methods Study PatientsIn CIN, acute renal failure tends to occur first, and thereafter some renal insufficiency may remain. Therefore, to investigate the effect of a contrast agent on renal function in the acute phase, Scr values before the use of a contrast agent, immediately after the use of a contrast agent (max. Scr within 2 weeks after use of a contrast agent), and after use of a contrast agent in the recovery phase (within 2 months after use of a contrast agent) were recorded. Among the patients who had been administered a contrast agent from July 1997 to April 2004, those with a Scr of less than 1.2 mg/dl before the administration of a contrast agent were classified as Group N (20 patients), and those having a Scr of at least 1.2 mg/dl but less than 2.0 mg/dl before administration of a contrast agent were categorized into the following 2 groups: Group D1: 10 patients without hemodiafiltration (HDF) after use of a contrast agent, and Group D2: 15 patients with HDF after use of a contrast agent.The subjects in groups N, D1, and D2 were selected randomly. All patients gave informed consent individually before enrolling. This study was approved by the Review Committee for Clinical Research of Yamaguchi University Hospital.The background of the patients is shown in Table 1. Glomerular filtration rate (GFR) was calculated using the Modification of Diet in Renal Disease Study (MDRD) method. 7 Scr was 0.85±0.18 mg/dl, 1.45±0.14 mg/dl, and 1.59±0.26mg/dl for Groups N, D1 and D2, respectively, and the respective GFR were 71.0±15.0ml/min, 36.8±4.1ml/min,...

Prediction of Chronic Renal Insufficiency After Coronary Angiography by an Early Increase in Oxidative Stress and Decrease in Glomerular Filtration Rate

“…15 CIN accounts for 12% of the acute kidney injury cases that occur in hospitals, and approximately 30% of patients develop renal dysfunction or chronic renal failure. 16 An animal model using old spontaneously hypertensive male rats showed that high osmolar contrast media could enhance the progression of glomerulosclerosis and renal failure.…”

“…It is likely to be considered that the contrast-induced elevated oxidative stress was transient because a rise in sCr level usually returns to the basal level within 2 weeks. 15 It might also be appropriate to consider that the patients with an increased sCr level after coronary angiography, even within a normal sCr level range, have inapparent renal insufficiency. Administration of a contrast agent might work as a challenge test to become evident in renal insufficiency.…”

Sodium Bicarbonate Improves Long-Term Clinical Outcomes Compared With Sodium Chloride in Patients With Chronic Kidney Disease Undergoing an Emergent Coronary Procedure

“…Previous studies reported that the use of contrast media is an independent factor that promotes chronic renal insufficiency and even mild renal insufficiency is associated with a dramatic increase in adverse clinical events, both periprocedurally and during long-term follow-up, in patients undergoing percutaneous interventions. 2,20 In particular, renal insufficiency is reported to be associated with increased risk of infection, upper gastrointestinal bleeding and cerebral infarction, which were causes of death in the present study. [21][22][23][24] Thus, we hypothesize that sodium bicarbonate attenuates acute renal injury after exposure to contrast media and improves long-term outcomes by reducing persistent renal insufficiency caused by glomerular over-filtration in residual nephrons and the release of neurohormones that reduce renal blood flow.…”

Guidelines on the use of iodinated contrast media in patients with kidney disease 2012: digest version

“…It has been reported that 60-90 % of the contrast medium is removed during 1 session of hemodialysis. Clinical studies have been conducted on the basis of these findings to investigate the efficacy of hemodialysis, hemodiafiltration, and hemofiltration in the prevention of CIN [160][161][162][163][164][165][166][167][168][169]. However, most studies could not demonstrate the efficacy of these procedures in the prevention of CIN.…”