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Renalguard, hemofiltration and hydration in prevention of contrast induced nephropathy in patients with severe chronic kidney disease undergoing percutaneous vascular interventions

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Abstract: P5445

Renalguard, hemofiltration and hydration in prevention of contrast induced nephropathy in patients with severe chronic kidney disease undergoing percutaneous vascular interventions

Authors:

L. Bertelli1, L. Politi1, S. Roversi1, Y. Bartolacelli1, S. Perrone2, M. Becirovic1, G. Biondi Zoccai1, F. Bursi1, G.M. Sangiorgi1, M.G. Modena1, 1University of Modena & Reggio Emilia, Department of Cardiology ­ Modena ­ Italy,  2University of Modena & Reggio Emilia, Department of nephrology ­ Modena ­ Italy, Topic(s): Invasive coronary imaging Citation:  European Heart Journal ( 2012 ) 33 ( Abstract Supplement ), 1003­1004 Background: Contrast­induced nephropathy (CIN) is a frequent complication of percutaneous coronary and peripheral artery interventions and is associated with significant in­hospital and long­term morbidity and mortality. We aim to compare the impact on major events of RenalGuard system(RG), continuous veno­venous Hemofiltration (CVVH) and hydration (Hy) with sodium bicarbonate plus N­acetylcysteine in patients with severe renal failure. Methods: We assigned 100 consecutive not dialyzed patients with severe renal failure (eGFR ≤30 mL/min x 1.73m2 or with a baseline SerumCreatinine > 1.5 mg/dL, or with a CIN risk score ≥ 11) scheduled for an elective percutaneous coronary and/or peripheral interventions to a preventive strategy with RG (33 pts), CVVH (35 pts) or Hy (32 pts). Primary end points were In­Hospital and 1 month dialysis and MACEs, and CIN. Secondarily, 6­Month MACEs were recorded. Results: In­H dialysis occurred in none of RG patients, 7 (20%) of CVVH patients vs 2 (6.3%) of Hy group (p=0.013). In­H MACEs were significantly less frequent in RG procedure [RG: 2 (6.1%), CVVH: 13 (37.1%) and Hy: 4 (12.5%) p=0.003; OR RGvs CVVH: 0.12; CI:0.02­0.60, p=0.01]. Similar trends were seen at 1 and 6 month follow­up (Fig). Particularly, none of RG patients died at 6 month FU, vs 9 (25.7%) CVVH patients and 2 (6.3%) Hydration protocol patients (p=0.002). Albeit not significant, CIN occurred less frequently in RG patients (15.2%) than CVVH (31.4%) and hydration protocol (25.0%) (p=0.288). Conclusions: For the first time, RenalGuard, CVVH and hydration with sodium bicarbonate and N­ acetylcysteine were compared in a real­world population: RG demonstrated to be safe and to significantly reduce risk of In­Hospital, 1 month and 6 month MACEs, compared to continuous veno­venous Hemofiltration and Hydration. Figure 1. Survival free from MACE

(2)

Abstract: P5445

Renalguard, hemofiltration and hydration in prevention of contrast induced nephropathy in patients with severe chronic kidney disease undergoing percutaneous vascular interventions

Authors:

L. Bertelli1, L. Politi1, S. Roversi1, Y. Bartolacelli1, S. Perrone2, M. Becirovic1, G. Biondi Zoccai1, F. Bursi1, G.M. Sangiorgi1, M.G. Modena1, 1University of Modena & Reggio Emilia, Department of Cardiology ­ Modena ­ Italy,  2University of Modena & Reggio Emilia, Department of nephrology ­ Modena ­ Italy, Topic(s): Invasive coronary imaging Citation:  European Heart Journal ( 2012 ) 33 ( Abstract Supplement ), 1003­1004 Background: Contrast­induced nephropathy (CIN) is a frequent complication of percutaneous coronary and peripheral artery interventions and is associated with significant in­hospital and long­term morbidity and mortality. We aim to compare the impact on major events of RenalGuard system(RG), continuous veno­venous Hemofiltration (CVVH) and hydration (Hy) with sodium bicarbonate plus N­acetylcysteine in patients with severe renal failure. Methods: We assigned 100 consecutive not dialyzed patients with severe renal failure (eGFR ≤30 mL/min x 1.73m2 or with a baseline SerumCreatinine > 1.5 mg/dL, or with a CIN risk score ≥ 11) scheduled for an elective percutaneous coronary and/or peripheral interventions to a preventive strategy with RG (33 pts), CVVH (35 pts) or Hy (32 pts). Primary end points were In­Hospital and 1 month dialysis and MACEs, and CIN. Secondarily, 6­Month MACEs were recorded. Results: In­H dialysis occurred in none of RG patients, 7 (20%) of CVVH patients vs 2 (6.3%) of Hy group (p=0.013). In­H MACEs were significantly less frequent in RG procedure [RG: 2 (6.1%), CVVH: 13 (37.1%) and Hy: 4 (12.5%) p=0.003; OR RGvs CVVH: 0.12; CI:0.02­0.60, p=0.01]. Similar trends were seen at 1 and 6 month follow­up (Fig). Particularly, none of RG patients died at 6 month FU, vs 9 (25.7%) CVVH patients and 2 (6.3%) Hydration protocol patients (p=0.002). Albeit not significant, CIN occurred less frequently in RG patients (15.2%) than CVVH (31.4%) and hydration protocol (25.0%) (p=0.288). Conclusions: For the first time, RenalGuard, CVVH and hydration with sodium bicarbonate and N­ acetylcysteine were compared in a real­world population: RG demonstrated to be safe and to significantly reduce risk of In­Hospital, 1 month and 6 month MACEs, compared to continuous veno­venous Hemofiltration and Hydration. Figure 1. Survival free from MACE

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