Zero-contrast percutaneous coronary interventions to preserve kidney function in patients with severe renal impairment and hemodialysis subjects

Introduction
Zero-contrast percutaneous coronary intervention (zero-PCI) is a new method for prevention of contrast-induced acute kidney injury (AKI) in patients with chronic kidney disease (CKD). However, evidence for its feasibility, safety and clinical utility is limited to reports of single cases or series of patients.

Aim
To present outcomes of zero-PCI in patients with severe CKD, including hemodialysis subjects, who were treated with this procedure in order to preserve their renal function.

Material and methods
Twenty-nine zero-PCIs were performed, mostly as a staged procedure, in 20 patients with advanced CKD. In this group, 4 patients were treated with hemodialysis but presented preserved residual renal function. The estimated median risk for contrast-induced AKI in non-dialysis patients was 26% (26–57%).

Results
Zero-PCI was feasible in each intended patient, including those with complex left main stenosis or lesion within a saphenous vein graft, and there was no specific complication associated with this technique. After the procedure, the factual AKI prevalence was 10% and no patient required renal replacement therapy. Three of 4 hemodialysis patients preserved their residual renal function. During the median follow-up of 3.2 (1.2–5.3) months no patient experienced an acute coronary event or required revascularization.

Conclusions
Zero-PCI is a safe and promising method to preserve renal function in patients with CKD and hemodialysis patients. Such an approach is feasible even in complex coronary lesions and yields good clinical outcomes in mid-term observation.