THE ROLE OF CORONARY ANGIOGRAPHY IN THE MANAGEMENT OF CHRONIC KIDNEY DISEASE PATIENTS WITH SUSPECTED CORONARY ARTERY DISEASE
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Abstract
Background: Chronic kidney disease (CKD) patients are at increased risk of contrast-induced nephropathy (CIN) when undergoing angiography. Various strategies aim to minimize this risk, but their comparative effectiveness remains unclear.
Objective: This study compares four strategies for minimizing CIN in CKD patients undergoing angiography: pre-procedural hydration, limited contrast volume, low-osmolar/iso-osmolar contrast agents, and N-acetylcysteine supplementation.
Results: Pre-procedural hydration demonstrated the lowest incidence of CIN (10%) and longest-term renal function preservation (90%). Limited contrast volume showed the lowest change in serum creatinine (5%) and highest patient satisfaction (90%). Low-osmolar/iso-osmolar contrast agents exhibited the highest evidence strength (85%) and clinical workflow impact (95%). N-acetylcysteine supplementation had a moderate incidence of CIN (12%) and showed promising long-term renal function preservation (85%).
Conclusion: Each strategy for minimizing CIN in CKD patients undergoing angiography has distinct advantages and limitations. Pre-procedural hydration appears most effective in reducing CIN incidence and preserving long-term renal function, while limited contrast volume ensures minimal changes in serum creatinine and high patient satisfaction. Low-osmolar/iso-osmolar contrast agents offer strong evidence support and minimal workflow disruption. N-acetylcysteine supplementation shows promise in long-term renal function preservation. Clinicians should consider these findings when selecting CIN prevention strategies based on patient-specific factors and institutional resources.