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| − | + | The authors postulated instead that sodium bicarbonate may reduce the formation of oxygen free radicals (a pH-dependent reaction), previously reported to play a pathogenetic role in CI-AKI.116 Four recent meta-analyses117?120 evaluating the protective effects of hydration with NaHCO3 compared with hydration with normal saline have shown NaHCO3 to be more effective in preventing CI-AKI by 54�C63%: (RR: 0.37, 95% CI: 0.18�C0.74); (RR: 0.45; 95% CI; 0.26�C0.79); (RR: 0.46; 95% CI: 0.26�C0.82); and (RR: 0.52; 95% CI: 0.34�C0.80). (v) [http://en.wikipedia.org/wiki/Ankyrin ankyrin] Hemodialysis and Hemofiltration Numerous studies have demonstrated that 2�C3 hours of hemodialysis effectively removes 60�C90% of contrast medium.121 Several studies explored the prophylactic value of hemodialysis in high risk patients, [http://www.selleckchem.com/products/JNJ-26481585.html HDAC inhibitor] but most failed to demonstrate a reduced incidence of CI-AKI.121 On the other hand, Marenzi et?al122 recently found that hemofiltration significantly reduced CI-AKI in patients at high risk. In this study, patients with chronic kidney disease undergoing coronary angiography were randomized to undergo either hemofiltration in an intensive care unit or parenteral saline hydration. Hemofiltration was started 4�C6 hours before contrast administration, stopped for coronary angiography, then resumed for an additional 18�C24 hours. Isotonic saline was used as replacement fluid and was given at a rate of 1 L/hour, which matched the ultrafiltration rate so that no net fluid loss resulted. In the control group, isotonic saline was given at 1 ml/kg/hr for 6�C8 hours before and 24 hours after angiography. The incidence of CI-AKI was 5% in the hemofiltration group compared with 50% in the control group (p [http://www.selleckchem.com/GSK-3.html GSK3 inhibitor] not account for differences in mortality. Moreover, the mortality rate in the control group was inordinately high, suggesting that it was not a good representative cohort. Both groups received?an extraordinary volume of contrast (approximately 250 ml) for patients with moderately sever chronic kidney disease (their baseline mean creatinine concentration was 3.0 mg/dl). Conclusions Given these reservations, due to the logistical effort and high cost associated with hemofiltration, larger randomized trials should be performed before this technique can be recommended as standard prophylaxis against CI-AKI in high-risk patients. Somewhat related is the not infrequent clinical question?of when to perform the next hemodialysis treatment in a patient undergoing chronic hemodialysis who receives intravascular contrast media. | |
Version du 4 novembre 2016 à 18:29
The authors postulated instead that sodium bicarbonate may reduce the formation of oxygen free radicals (a pH-dependent reaction), previously reported to play a pathogenetic role in CI-AKI.116 Four recent meta-analyses117?120 evaluating the protective effects of hydration with NaHCO3 compared with hydration with normal saline have shown NaHCO3 to be more effective in preventing CI-AKI by 54�C63%: (RR: 0.37, 95% CI: 0.18�C0.74); (RR: 0.45; 95% CI; 0.26�C0.79); (RR: 0.46; 95% CI: 0.26�C0.82); and (RR: 0.52; 95% CI: 0.34�C0.80). (v) ankyrin Hemodialysis and Hemofiltration Numerous studies have demonstrated that 2�C3 hours of hemodialysis effectively removes 60�C90% of contrast medium.121 Several studies explored the prophylactic value of hemodialysis in high risk patients, HDAC inhibitor but most failed to demonstrate a reduced incidence of CI-AKI.121 On the other hand, Marenzi et?al122 recently found that hemofiltration significantly reduced CI-AKI in patients at high risk. In this study, patients with chronic kidney disease undergoing coronary angiography were randomized to undergo either hemofiltration in an intensive care unit or parenteral saline hydration. Hemofiltration was started 4�C6 hours before contrast administration, stopped for coronary angiography, then resumed for an additional 18�C24 hours. Isotonic saline was used as replacement fluid and was given at a rate of 1 L/hour, which matched the ultrafiltration rate so that no net fluid loss resulted. In the control group, isotonic saline was given at 1 ml/kg/hr for 6�C8 hours before and 24 hours after angiography. The incidence of CI-AKI was 5% in the hemofiltration group compared with 50% in the control group (p GSK3 inhibitor not account for differences in mortality. Moreover, the mortality rate in the control group was inordinately high, suggesting that it was not a good representative cohort. Both groups received?an extraordinary volume of contrast (approximately 250 ml) for patients with moderately sever chronic kidney disease (their baseline mean creatinine concentration was 3.0 mg/dl). Conclusions Given these reservations, due to the logistical effort and high cost associated with hemofiltration, larger randomized trials should be performed before this technique can be recommended as standard prophylaxis against CI-AKI in high-risk patients. Somewhat related is the not infrequent clinical question?of when to perform the next hemodialysis treatment in a patient undergoing chronic hemodialysis who receives intravascular contrast media.
