Protocol Cuts Renal Risk

Mitchel L. Zoler

ORLANDO -- A simple renal protection protocol cut incidence of new-onset hemodialysis by about 27% among patients undergoing coronary catheterization, reported Aaron D. Kugelmass, M.D., and his colleagues at Henry Ford Hospital in Detroit in a poster presented at the annual meeting of the American College of Cardiology.

The renal protection protocol involved three steps: identifying a patient's creatinine load before catheterization, calculating the patient's maximum contrast dose, and informing the cardiologist periodically during the procedure about the total contrast load that had been used.

The efficacy of this protocol was reviewed for 60,533 consecutive patients who underwent cardiac catheterization during January 2002-June 2003 at any one of 25 hospitals run by HCA Inc., a Nashville-based hospital management company. Thirteen participating hospitals used the renal protection protocol throughout the study. Five hospitals did not use the protocol throughout the study, and seven hospitals implemented it during the study period. The result was that 47,001 patients had catheterizations with the protocol in place, and 13,532 had catheterizations done without the protocol.

Subsequent to catheterization, about 250 patients in the group without renal protection (1.9%), and about 540 patients in the renal protection group (1.2%) developed new-onset hemodialysis, said Dr. Kugelmass. In a logistic regression model, patients treated using the protocol had a significant 27% reduced risk of new-onset hemodialysis, compared with those not protected. But the renal protocol had no significant impact on in-hospital mortality or on the development of acute renal failure.