Authors: Holger Reinecke Manfred Fobker Jürgen Wellmann Birgit Becke Jörn Fleiter Christine Heitmeyer Günter Breithardt HansWerner Hense Roland M Schaefer
Publish Date: 2006/12/22
Volume: 96, Issue: 3, Pages: 130-
Abstract
Contrast mediuminduced nephropathy CIN is a serious complication with increasing frequency and an unfavorable prognosis Previous analyses of surrogate parameters have suggested beneficial effects of hemodialysis that are assessed in this randomized clinical trialWe performed a prospective singlecenter trial in 424 consecutive patients with serum creatinine concentrations between 13– 35 mg/dl who underwent elective coronary angiography Patients were randomized to one of three treatment strategies with all patients receiving pre and postprocedural hydration One group received no additional therapy patients in the second group were hemodialyzed once and the third group received oral Nacetylcysteine The frequency of CIN defined as an increase in serum creatinine ≥05 mg/dl from 48 to 72 h after catheterization was 61 in the hydrationonly group 159 with hemodialysis treatment and 53 in the NACC group intentiontotreat analysis P = 0008 There were no differences between the treatment groups with regard to increased ≥ 05 mg/dl serum creatinine concentrations after 30–60 days 48 51 and 31 respectively P = 0700 Analyses of longterm followup range 63 to 1316 days by Cox regressions models of the study groups found quite similar survival rates P = 0500 In contrast to other retrospective studies longterm survival of patients with vs those without CIN within 72 h was not different but patients who still had elevated creatinine concentrations at 30–60 days suffered from a markedly higher 2year mortality 46 vs 17 P = 0002In conclusion hemodialysis in addition to hydration therapy for the prevention of CIN provided no evidence for any outcome benefit but evidence for probable harm Increased creatinine concentrations at 30–60 days but not within 72 h were associated with markedly reduced longterm survivalPreliminary results of this trial have been presented as a poster on the annual congress of the European Society of Cardiology in Berlin 2002 Reinecke H Dieckmann T Fleiter J Fobker M Matzkies F Harz C Schaefer R 2002 Prevention of contrast mediainduced renal failure after coronary angiography – First results of the Diuresis vs Dialysis DVD Study Eur Heart J 23Abstr Suppl701
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