NEW YORK (Reuters Health) - Pre- and post-procedural hemofiltration appears to be the best means of preventing nephropathy caused by contrast medium administration in patients with chronic kidney disease, according to Italian researchers.

"Hemofiltration," lead investigator Dr. Giancarlo Marenzi told Reuters Health, "has recently been demonstrated to be a very effective prophylactic strategy against contrast-induced nephropathy in patients with severe chronic renal failure undergoing invasive cardiovascular procedures."

Dr. Marenzi of Centro Cardiologico Monzeno, Milan and colleagues investigated what factors were required for the greatest success in preventing nephropathy in this setting. As described in the February issue of the American Journal of Medicine, they randomized 92 patients with chronic kidney disease to three different prophylactic procedures.

These consisted of intravenous hydration with saline before and after contrast exposure; intravenous hydration before exposure and hemofiltration for up to 24 hours after exposure; and hemofiltration performed for 6 hours before exposure and for up to 24 hours thereafter.

In total, 12 (40%) of the patients given hydration alone experienced nephropathy and nine required hemodialysis. In-hospital mortality was 20% in this group.

Of the patients who had hydration followed by hemofiltration, eight (26%) experienced nephropathy and three required hemodialysis. In-hospital mortality was 10%.

Only one patient (3%) given hemofiltration before and after the procedure developed nephropathy. None of the patients required hemodialysis and there were no in-hospital deaths.

"This study," continued Dr. Marenzi, "confirms our previous findings and shows that a pre-procedural hemofiltration session is necessarily required to obtain the full clinical benefit, indicating that controlled high-volume hydration before contrast exposure is likely an important mechanism of action."

Am J Med 2006;119:155-162

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