1. KamalMohamed OkashaMD
Prof of Internal Medicine and Nephrology
Tanta University
Fellow of nephrology and Renal Tx
SaskUniversity, Canada

2. Agenda
•Overview.
•Role of RRT in Prevention of CIN.
•Current CIN Guidelines.
•Conclusion.

3. Agenda
•Role of RRT in Prevention of CIN.
•Current CIN Guidelines.
•Conclusion.

4. Overview
•Contrastnephropathy(CN)isamajorcomplicationaftercoronaryinterventionandisthethirdleadingcauseofhospital-acquiredacuterenalfailure.
•Becausepreexistingrenaldysfunctionisthemostimportantriskfactor,theincidenceofacuterenalshutdownaftercoronaryangiography(CAG)isquitehighinpatientswithchronicrenalfailure.
RihalCS,TextorSC,GrillDE,etal.Incidenceandprognosticimportanceofacuterenal
failureafterpercutaneouscoronaryintervention.Circulation2002;105:2259–64.

5. Overview
•Contrastmediaareexcretedmainlybyglomerularfiltration.Theeliminationisslowinpatientswithchronicrenalfailure;therefore,itwouldmakethesevulnerablepatientsexposedtocontrastmedialonger.
•Itisknownthatcontrastmediacanbeeffectivelyremovedfromthebloodofpatientswithchronicrenalfailurebyhemodialysis.
LorussoV,TaroniP,AlvinoS,SpinazziA.Pharmacokineticsandsafetyofiomeprolinhealthy
volunteersandinpatientswithrenalimpairmentorendstagerenaldiseaserequiring
haemodialysis.InvestRadiol2001;36:309–16.

6. Agenda
•Overview.
•Current CIN Guidelines.
•Conclusion.

16. N EnglJ Med 2003;349:1333-40.

28. Agenda
•Overview.
•Role of RRT in Prevention of CIN.
•Conclusion.

33. •Radiocontrastmaterialscanbeeasilyremovedwithhemodialysis,howeverthereisnoevidencethatthisremovalreducestheriskofCIN.

35. •WedoNOTrecommendRoutinehemofiltrationorhemodialysisforthepreventionofcontrastnephropathyinpatientswithCKD.
•Thereisnoindicationforprophylacticdialysisforthepreventionofvolumeoverloadindialysis-dependentpatients.
•Furthermore,therearenostudiesthatsupportimmediatedialysisafterintravascularcontrastmediaadministrationinordertopreserveresidualrenalfunctionorlimittheriskofallergicreactioninhemodialysispatients.
HamaniA,NephrolDialTransplant1998;13:1051.
RodbyRA.SeminDial2007;20:19.
TakebayashiS,AmJKidneyDis2000;36:226.

36. Agenda
•Overview.
•Role of RRT in Prevention of CIN.
•Current CIN Guidelines.

37. •RoleofRRTforpreventionofRCI-AKIisstillcontroversial.
•TheRRTistailoredaccordingtotheclinicaljudgment.
•LargeRCTsarestillneededtooptimizetheneedanduseofRRTinsuchconditions.

38. “An ounce of prevention is worth a pound of cure”
Benjamin Franklin