麻豆传媒

Using coronary angiography to test whether a patient's heart is fit enough to undergo kidney transplant is not as dangerous as once thought, researchers found.

Among patients with advanced chronic kidney disease (CKD), mean glomerular filtration rate (GFR) did not change significantly six months before or after angiography, Nicola Kumar, MBChB, of Imperial College London, and colleagues reported online in the Clinical Journal of the American Society of Nephrology.

"The data suggest coronary angiography screening does not accelerate the decline in renal function for patients with advanced CKD, facilitating a safe preemptive transplant program," the researchers said. "A transient decline in GFR was demonstrated in the first week following coronary angiography but this was entirely reversible."

Physicians have cautioned that the use of dyes and x-rays involved in angiography puts kidney patients at an increased risk of complications from the procedure. There have also been concerns that contrast-induced nephropathy and cholesterol embolization syndrome may precipitate the need for chronic dialysis.

However, the researchers said, the safety of the procedure has improved.

So they conducted a retrospective study of 76 patients with late-stage CKD who were potential transplant recipients seen at clinics from 2004 to 2007. Kidney function measurements were recorded 12 months before and 12 months after patients had coronary angiography.

The researchers found that patients' kidney function was similar before and after the procedure.

Mean GFR at coronary angiography was about 12.46 ml/min, and that was not significantly different six months before and six months after the procedure, the researchers said.

Cumulative dialysis-free survival was 89.1% six months after angiography.

The researchers noted that there was a temporary decline in eGFR following administration of contrast media, but it was only transient.

The technique detected coronary artery disease in 23 patients (30.3%), making them unsuitable for transplantation until their heart complications were addressed.

Yet 32.9% of patients were eligible and had transplantation, with 88% of those being performed preemptively.

A total of 17.1% of patients started dialysis during follow-up, the researchers said.

None of the patients needed dialysis immediately after contrast administration, and only one started dialysis within three months of angiography, they added.

The researchers acknowledged that their study may have been limited by the potential for missing data, but concluded that coronary angiography screening doesn't accelerate the decline in renal function for patients with advanced CKD.

"If the procedure is performed appropriately with small volumes of contrast, biplane angiography using N-Acetylcysteine and adequate hydration around the time of the procedure," the researchers said, "then the risk of contrast exposure can be minimized in this population."