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Decreasing Contrast Induced Nephropathy With Targeted Renal Therapy
James C. Prueter, Thomas Khoury, MD FACS FICS.
Southern Ohio Medical Center, Portsmouth, OH, USA.

OBJECTIVES:Radiocontrast imaging has increasingly become a popular diagnostic and therapeutic technique. The advantages of a percutaneous approach generally include shorter hospitalization, less pain, lower occurrence of infection and minimal blood loss. Minimally invasive percutaneous procedures require the use of radiocontrast media which has been shown to cause acute renal failure, also known as radiocontrast induced nephropathy. Prophylactic treatments include sodium bicarbonate, N-acetylcysteine, hydration, hemodialysis or hemofiltration and systemic infusion of fenoldopam. To further minimize the disadvantages of radiocontrast media and to prevent nephropathy, the Benephit catheter is targeted renal therapy in which the delivery of the therapeutic agent is directly to the kidney by infusing within the renal arteries. The therapeutic agent of choice in this trial is fenoldopam, a D-1 receptor agonist.
METHODS: A total of 212 patients underwent angiography. Of those, 20 qualified for the use of Benephit catheter infusion. Inclusion criteria: pre-op Cr ≥1.3. Patients on dialysis were excluded from study. Data (pre and post operative Cr) was collected retrospectively.
RESULTS: The average pre-op Cr among these patients was 1.7 and improved to an average of 1.5 post-operatively. Overall, the average improvement was 11.5% and maximum was 46.2%. Two patients had no change. The Benephit catheter has a 95% success rate of either maintaining or improving kidney function after angiography.
CONCLUSIONS:Administration of N-ac, bicarb and hydration are shown, by the results of this trial, to be effective in just over 60% of patients with renal insufficiency. In order to prevent contrast induced nephropathy in patients, more medical therapy must be done. At this time, it appears that the addition of targeted renal therapy with direct infusion of fenoldopam has a 95% success rate of preventing contrast induced nephropathy.


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