Clinical Health Updates

Prophylactic dialysis reduces long-term dialysis in pts with renal failure after coronary angiography

Clinical Question:
In patients with advanced renal failure, does prophylactic hemodialysis after coronary angiography reduce the need for long-term dialysis?

Bottom Line:
Prophylactic hemodialysis after coronary angiography in patients with renal failure reduces the need for long-term dialysis without causing complications.

Lee P, Chou K, Liu C, et al. Renal protection for coronary angiography in advanced renal failure patients by prophylactic hemodialysis. A randomized controlled trial. J Am Coll Cardiol 2007;50(11):1015-1020.

Study Design:
Randomized controlled trial (nonblind)

Patients requiring coronary angiography who had a serum creatinine concentration greater than 3.5 mg/dL (and had been stable for 1 month) were randomized to receive hemodialysis or no hemodialysis following angiography. Acetylcysteine and mannitol were not permitted during the study. Angiography was done with nonionic contrast. The primary end point was the change in creatinine clearance (CrCl) between baseline and day 4 following angiography.
Ninety patients were randomized, and 8 of them were excluded because of insufficient follow up, taking drugs not permitted by protocol, or having a second contrast procedure within 28 hours. Intention-to-treat analysis was not used. Patients were matched for baseline characteristics. Half the patients required percutaneous coronary intervention. At day 4, patients receiving prophylactic dialysis had less decline in CrCl (-0.4 vs -2.2 ml/min/1.73m2). Temporary dialysis was required in 2% of the dialysis group versus 14% of the control group, and maintenance dialysis following discharge was required in 13% of the control patients but none of the dialysis patients [number needed to treat = 8; 95% CI, 4 – 64]. Prophylactic dialysis resulted in shorter hospital stays (6 days vs 13 days; P = .017). No major complications occurred as a result of dialysis.