Abstract 13968: Beneficial Effects of a Single Prophylactic Hemodialysis on Renal Function Worsening after Percutaneous Coronary Intervention in Patients with Severe CKD
Background: Renal function worsening after percutaneous coronary intervention (PCI) in patients with chronic kidney disease (CKD) is an important and common clinical scenario. Although the hemodialysis is an exclusive therapy for acute kidney injury, the effect of prophylactic hemodialysis (pHD) to prevent renal function worsening after PCI remains controversial. In this study, we thus examined the effectiveness of pHD after PCI in severe CKD patients. Methods and Result: We prospectively enrolled 37 consecutive non-dialysis patients with severe CKD (eGFR<30 ml/min/1.73m2) who underwent PCI (M/F 23/14, 71±10 [SD] years) in our hospital between 2008 and 2011. All patients received a sufficient amount of saline before and after PCI and were divided into 2 groups with and without a single pHD after PCI; pHD (n=18) and non-pHD (n=19) groups. Although most baseline characteristics (e.g. BNP, hs-CRP and urinary albumin excretion levels) were comparable between the 2 groups, eGFR was significantly lower in the pHD group (20.2±6.1 vs. 26.3±4.1 ml/min/1.73m2, P<0.05). The incidence of contrast-induced nephropathy, defined as increase in serum creatinine (sCre)>25% and/or >0.5 mg/dl within 72 hours after PCI, tended to be lower in the pHD group (6% vs. 22%, P=0.18). The %change in sCre and eGFR from baseline at 72 hours after PCI were better in the pHD than in the non-pHD group (sCre, -1.7±8.5% vs. 14.9±37.2%, P<0.05; eGFR, 2.7±19.1% vs. -10.4±24.3%, P<0.05) and this beneficial effect of a single pHD persisted for more than a month (%change in sCre level from baseline to 1 month after PCI, 4.6±19.1% vs. 30.7±40.4%, P<0.05; eGFR, 0.3±30.1% vs. -21.4±22.4%, P<0.01). Furthermore, we noted that renal function gradually worsened over time until 6 to 8 months after PCI in patients in the non-pHD group but not in those in the pHD group (Figure). Conclusion: A single pHD may be effective to prevent the contrast-induced renal function worsening after PCI in patients with severe CKD.
- © 2012 by American Heart Association, Inc.