ABSTRACT
CIN is usually predictable, due to the fact that its risk factors are well known. This offers an opportunity to utilize preventive strategies. Among several prophylactic approaches, only hydration and the use of antioxidant agents (acetylcysteine, ascorbic acid), bicarbonate, and isoosmolar and low-osmolar contrast agents have been shown to provide some protection.10-15
However, their efficacy in patients with severe CRF is still controversial, and their impact on clinical outcome is completely unknown. To date, patients with severe CRF, undergoing coronary angiography and PCI, continue to have a risk of CIN that approximates 50%, and an associated cardiovascular death rate of 30% within 1 year.16-18 In endstage renal disease, chronic dialysis treatment does not offer significant protection against this increased risk. In two studies, the 2-year survival of dialysis patients after PCI was reported to range between 48% and 53%.19,20
Hence, more effective prophylactic strategies are needed to attenuate the particularly high risk associated with invasive cardiovascular procedures in patients with CRF.The potential protective effects and therapeutic advantage of a non-pharmacologic approach, based on the use of renal replacement therapies (RRT), such as hemodialysis, hemofiltration, and hemodiafiltration, have been a matter of intense investigative interest in recent years.
