Kamal Mohamed Okasha MDProf of Internal Medicine and Nephrology

Tanta UniversityFellow of nephrology and Renal Tx

Sask University, Canada

Agenda

• Overview.

• Role of RRT in Prevention of CIN.

• Current CIN Guidelines.

• Conclusion.

Agenda

• Role of RRT in Prevention of CIN.

• Current CIN Guidelines.

• Conclusion.

Overview

• Contrast nephropathy (CN) is a majorcomplication after coronary intervention and isthe third leading cause of hospital-acquired acuterenal failure.

• Because preexisting renal dysfunction is the mostimportant risk factor, the incidence of acute renalshutdown after coronary angiography (CAG) isquite high in patients with chronic renal failure.

Rihal CS, Textor SC, Grill DE, et al. Incidence and prognostic importance of acute renalfailure after percutaneous coronary intervention. Circulation 2002;105:2259–64.

Overview

• Contrast media are excreted mainly by glomerularfiltration. The elimination is slow in patients with chronicrenal failure; therefore, it would make these vulnerablepatients exposed to contrast media longer.

• It is known that contrast media can be effectivelyremoved from the blood of patients with chronic renalfailure by hemodialysis.

Lorusso V, Taroni P, Alvino S, Spinazzi A. Pharmacokinetics and safety of iomeprol in healthy

volunteers and in patients with renal impairment or end stage renal disease requiring

haemodialysis. Invest Radiol 2001;36:309 –16.

Agenda

• Overview.

• Current CIN Guidelines.

• Conclusion.

N Engl J Med 2003;349:1333-40.

Agenda

• Overview.

• Role of RRT in Prevention of CIN.

• Conclusion.

• Radiocontrast materials can be easily removed withhemodialysis, however there is no evidence that thisremoval reduces the risk of CIN.

• We do NOT recommend Routine hemofiltration orhemodialysis for the prevention of contrast nephropathy inpatients with CKD.

• There is no indication for prophylactic dialysis for theprevention of volume overload in dialysis-dependentpatients.

• Furthermore, there are no studies that support immediatedialysis after intravascular contrast media administration inorder to preserve residual renal function or limit the risk ofallergic reaction in hemodialysis patients.

Hamani A, Nephrol Dial Transplant 1998; 13:1051.Rodby RA. Semin Dial 2007; 20:19.Takebayashi S, Am J Kidney Dis 2000; 36:226.

Agenda

• Overview.

• Role of RRT in Prevention of CIN.

• Current CIN Guidelines.

• Role of RRT for prevention of RCI-AKI is stillcontroversial.

• The RRT is tailored according to the clinicaljudgment.

• Large RCTs are still needed to optimize theneed and use of RRT in such conditions.

“An ounce of prevention is worth a pound of cure”

Benjamin Franklin