Low Incidence of Contrast Induced Nephropathy after Coronary Angiography in Patients with Advanced Chronic Kidney Disease Treated with Prophylactic Continuous Veno-venous Hemofiltration

Introduction: Contrast-induced nephropathy (CIN) is associated with increased risk of in-hospital morbidity and mortality. The purpose of this study was to find out whether continuous venovenous hemofiltration (CVVH) after coronary angiography in chronic kidney disease (CKD) patients is associated with a lower incidence of CIN than that reported in the literature. Methods: All patients with CKD who underwent coronary angiography in the Chest Disease Hospital, Kuwait, between January 2004 and December 2005 were treated by CVVH after the procedure. Renal function was assessed before and after the procedure. Results: A total of 98 patients were enrolled in the study, 52 (53.1%) of whom were males. Their mean age was 60.7 years. Before the procedure, the mean serum creatinine level was 4.65 mg/dl and the mean creatinine clearance (Cr Cl) was 18.04 ml/min. Patients underwent CVVH for a mean duration of 21.3 hours, after a mean time-interval of 44.3 min. Their mean serum creatinine was 4.57 mg/dl at discharge (within the first week after the procedure) and 4.78 mg/dl at 15 days after the procedure. Mean Cr Cl was 18.52 ml/min at discharge and 17.62 ml/min at 15 days after the procedure. There was no statistically significant difference between the mean serum creatinine and Cr Cl values before and after the procedure. However, one patient (1.02%) developed CIN and ended on regular hemodialysis. The in-hospital mortality was 0%. Conclusion: Patients with advanced CKD who undergo coronary angiography may be protected from further deterioration in their renal function after exposure to radiological contrast material if the procedure is immediately followed by CVVH. A randomized controlled clinical trial is needed to verify our encouraging results. Keywords: contrast induced nephropathy, chronic kidney disease, continuous venovenous hemofiltratio