Use of ultra-low contrast volume is a safe, feasible, and effective way to prevent contrast-induced nephropathy (CIN) in patients with advanced chronic kidney disease (CKD) undergoing coronary procedures, researchers in Israel concluded.
The finding is from a prospective study of 30 patients undergoing coronary angiography or percutaneous coronary intervention (PCI). All patients had an estimated glomerular filtration rate below 45 mL/min/1.73 m2 (mean 31.8 mL/min/1.73 m2). The median contrast volume was 13 mL for diagnostic coronary angiography, with an additional 13 mL for PCI. Starting 12 hours before their procedure, all patients received prehydration with intravenous isotonic saline at a rate of 1 mL per kilogram of body weight per hour, or 0.5 mL per hour for patients who had severely reduced left ventricular function. The primary end point was development of CIN, defined as a 25% or greater increase in serum cystatin C or creatinine 48 hours following the coronary procedure.
At 48 hours post-procedure, 3 patients (10%) had a 25% or greater increase in serum cystatin C levels, but no patient had a 25% or greater increase in serum creatinine, Zach Rozenbaum, MD, of Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, and colleagues reported in Nephron Clinical Practice. After a follow-up period of 6 months, no patient required renal replacement therapy or unplanned coronary intervention, they noted.
“The current study is the first to demonstrate the feasibility and safety of coronary angiographic and PCI with ultra-low contrast volume in consecutive real-life patients with advanced chronic kidney disease,” the authors observed.
The investigators concluded that the use of ultra-low contrast volume may increase the use of PCI in high-risk coronary patients with CKD.
In addition, Dr Rozenbaum and his colleagues noted that since cystatin C was more sensitive than creatinine for detecting CIN, “future studies should prefer its use for the assessment of renal function following contrast exposure.”
Study participants had a mean age of 71 years. Of the 30 patients, 12 had nonsignificant coronary disease suitable for conservative treatment and 2 patients had multi-vessel disease requiring coronary artery bypass grafting and were referred for surgery. The remaining 16 patients underwent PCI.
With regard to study limitations, the researchers pointed out that their study was conducted at a single center with small number of patients. They noted that “it is not possible to arrive at definitive conclusions with such a small number.”
Rozenbaum Z, Benchetrit S, Rozenbaum E, et al. Ultra-low contrast volume for patients with advanced chronic kidney disease undergoing coronary proceudures. Nephron Clin Prac. 2018.