RESUMEN
BACKGROUND: There have been few studies regarding the effect of contrast agent on long-term renal function and, moreover, there are still many uncertainties regarding the efficacy of prophylactic hemodiafiltration (HDF) for contrast-induced nephropathy. METHODS AND RESULTS: Patients with heart disease and a serum creatinine level (Scr) of less than 1.2 mg/dl were classified as Group N (20 patients), those with Scr of at least 1.2 mg/dl but less than 2.0 mg/dl were classified as Group D1 (10 patients without HDF) and D2 (15 patients with HDF), respectively. For each group, a linear regression of 1/Scr was extrapolated using Scr measured more than 3 times during each period that was longer than 3 months before and after use of a contrast agent, and the slopes (constant k) thereof were compared. To remove the contrast agent, HDF was performed for 2 h. Group D1 showed a significant decrease in the k after use of the contrast agent (p<0.05). CONCLUSION: Use of a contrast agent is an independent factor that promotes chronic renal insufficiency and prophylactic HDF was found to effectively improve the long-term outcome of decreased renal function.
Asunto(s)
Medios de Contraste/efectos adversos , Hemodiafiltración/métodos , Riñón/fisiología , Insuficiencia Renal/inducido químicamente , Insuficiencia Renal/prevención & control , Anciano , Medios de Contraste/farmacología , Creatinina/sangre , Relación Dosis-Respuesta a Droga , Femenino , Estudios de Seguimiento , Humanos , Riñón/irrigación sanguínea , Riñón/efectos de los fármacos , Modelos Lineales , Masculino , Persona de Mediana Edad , Insuficiencia Renal/sangre , Estudios Retrospectivos , Factores de Tiempo , Resultado del TratamientoRESUMEN
OBJECTIVES: This study examined the efficacy of a novel system to remove contrast from the coronary sinus (CS) using an adsorbing column during coronary angiography. BACKGROUND: Contrast-induced nephropathy (CIN) has become a serious problem for patients with pre-existing renal insufficiency undergoing percutaneous coronary intervention (PCI). METHODS: Eight swine were studied to evaluate the efficacy of the contrast removal system. A newly developed 8-F blood suction catheter was inserted into the CS via the right femoral vein. The venous blood from the CS was transferred into the 500-ml contrast-adsorbing column using an extracorporeal system. A total of 155 ml of contrast medium was infused selectively into the coronary artery. Five swine were treated extracorporeally for 90 min using adsorbing columns, and three were treated without columns as a control group. RESULTS: The mean calculated iodine removal rate was 49.4%. The area under the curve of the iodine concentration in the group treated with the column was significantly smaller, by 60%, than that of the group treated without the column (p = 0.0003). No significant adverse effects were observed in the subjects' vital signs throughout the experiments. CONCLUSIONS: The contrast removal system from CS is effective and safe during coronary angiography in swine. This technique may be useful for preventing CIN in patients with renal insufficiency undergoing PCI.
Asunto(s)
Medios de Contraste , Angiografía Coronaria , Vasos Coronarios , Circulación Extracorporea , Yopamidol , Adsorción , Animales , Área Bajo la Curva , Recuento de Células Sanguíneas , Cateterismo , Medios de Contraste/efectos adversos , Arteria Femoral , Vena Femoral , Yodo/análisis , Enfermedades Renales/inducido químicamente , Enfermedades Renales/prevención & control , Succión , Porcinos , VenasRESUMEN
We developed a new method of hemodialysis using a charging chamber for treatment of hemodialysis patients with hypotension occurring during the latter half of hemodialysis (collapse). The purpose of this method was to recover systolic blood pressure (BP) by returning a part of blood within the chamber into the body circulation when hemodialysis collapse occurred. Using this method, systolic BP recovery (DeltaBP) in ten hemodialysis patients (4 males, 6 females, mean age 66.0 years old) was compared to a control group treated with intravenous administration of 20 ml of 10% NaCl. When hemodialysis collapse occurred, 60 ml of blood within the chamber in this method and 20 ml of 10% NaCl intravenously in the control group were administered and systolic BP was measured 20 minutes later. The results showed that DeltaBP using this method was 26.0 mm Hg (ANOVA: p = 0.0072), while in the control group it was 30.2 mm Hg (ANOVA: p = 0.0003), and there was no significant difference between the systolic BP recovery of both groups (paired t test: p = 0.4196).