Effect of continuous venovenous hemofiltration on prevention of contrast-induced nephropathy during percutaneous coronary intervention in elderly patients with chronic kidney disease

AIM To assess the value of continuous venovenous hemofiltration (CVVH) in the prevention of contrast-induced nephropathy (CIN) during percutaneous coronary intervention (PCI) in elderly patients with chronic kidney disease (CKD). METHODS We evaluated 60 CKD elderly patients undergoing PCI. The 60 elderly patients were divided into hemofiltration group (n=30) and hydration group (n=30) according to hemofiltration. In the hemofiltration group, hemofiltration was initiated 4 h before PCI and re-started immediately post-PCI for 18 h. In the hydration group, 0.9% NaCl 100 ml/h was given, respectively, for 12 h pre- and post-procedure. We measured serum creatinine levels before PCI and at 0 h, 24 h, 72 h and 1 week after PCI. We observed the incidence of CIN and the short-term clinical efficacy of hemofiltration. Long-term hemodialysis, non-fatal major cardiovascular events and death rates were compared between groups after the 6-month follow-up. RESULTS There was no significant difference in clinical characteristics (age, gender, mean arterial pressure, diabetes, hypertension, hyperlipidemia, creatinine, heart failure) between groups. There was a significant difference in serum creatinine levels (0 h, 24 h, 72 h and 1 week after PCI) between groups (P<0.05, P<0.01). Incidence of CIN was 7% in the hemofiltration group and 30% in the hydration group, with significant difference between groups (P<0.05). The 6-month follow-up ［mean (5.6±1.2) m］ found significant differences between groups in the cases dependent on long-term hemodialysis (one in the hemofiltration group and seven in the hydration group, P<0.05) and in non-fatal cardiovascular events (one in the hemofiltration group and six in the hydration group, P<0.05). There was no significant difference between groups in the death rate (one in the hemofiltration group and two in the hydration group). CONCLUSION For patients with renal insufficiency, hemofiltration during PCI may reduce the incidence of CIN and non-fatal cardiovascular events.