Lee PT et al. (2007) Renal protection for coronary angiography in advanced renal failure patients by prophylactic hemodialysis: a randomized controlled trial. J Am Coll Cardiol 50: 1015–1020

Pre-existing renal dysfunction is the main risk factor for contrast-induced nephropathy after coronary angiography. To date, there are no validated means of preventing this nephropathy in individuals with advanced renal failure. In a recent paper, Lee and co-workers report that prophylactic hemodialytic clearance of contrast media can prevent renal deterioration in these patients.

In total, 82 patients were enrolled in the study. All patients received normal saline before and after coronary angiography with nonionic iohexol; 42 of the patients also received prophylactic hemodialysis, started a mean 81 min after angiography. In the 72 h following coronary angiography, creatinine clearance rates (measured by 24 h urine collection) declined significantly less in the hemodialysis group than in the control group (−0.4 vs −2.2 ml/min/1.73 m2; P< 0.001). Serum creatinine concentrations increased in both groups after coronary angiography, but the increases were more marked in the control group (peak levels: 592 vs 469 µmol/l [6.7 vs 5.3 mg/dl]; P = 0.005). At discharge, 13 control patients and 2 hemodialysis patients had a serum creatinine concentration >88 µmol/l (>1 mg/dl) higher than their baseline levels. No major dialysis-related complications were reported, and patients who received this treatment were discharged sooner after coronary angiography than were control patients (6 vs 13 days; P = 0.017).

Temporary dialysis after coronary angiography was required by 14 (35%) control patients, with 5 requiring maintenance dialysis after discharge from hospital. By contrast, only one patient in the prophylactic dialysis group required temporary hemodialysis.