Background: Contrast-induced acute kidney injury (CI-AKI) is a frequent complication of coronary angiography associated with unfavorable outcome. Recently, two randomized controlled trials have demonstrated that furosemide induced diuresis with matched isotonic intravenous hydration using the RenalGuard system reduces the risk of CI-AKI in high-risk patients undergoing coronary procedures. The efficacy and safety of this strategy has never been reported in real life practice.
Methods: We analyzed data of patients at high risk to develop CI-AKI who were hospitalized in our cardiology department for acute coronary syndrome from August 2012 to September 2013 and were treated with the RenalGuard system during coronary angiography with or without angioplasty. The AKI rate was compared to a novel tool for accurate prediction of CI-AKI.
Results: 51 high risk patients were enrolled, 66% males, mean age of 74 ± 9 years, 93% where hypertensive and 55% were diabetics. Mean ejection fraction was 46±13%, mean eGFR was 37±13 ml/min/1.73m2 and mean baseline hemoglobin was 11.4±1.8 g/dL. The mean volume of contrast media delivered was 84±34 ml (25 - 172). According to a novel prediction tool patients in this group had a calculated risk of 10.5% for CI-AKI and 1.4 % risk of requiring dialysis.
Forced dieresis was achieved with mean IV normal saline bolus of 260±70 ml, and mean IV furosemide of 55±38 mg, achieving a mean urine rate of 443±258 ml/hr at the beginning of the procedure. Monitored by the RenalGuard system patients received a mean IV hydration saline of 2209 ± 1154 ml closely matched to mean urine output of 2486 ±1173 ml, during a mean time of 5 hours and 45 minutes. 3 patients (5.8%) developed CI-AKI as defined by >0.5 mg/dl or >25% rise in serum creatinine at 48–72 h post contrast administration and non required dialysis. 2 Patients (3.9%) developed dyspnea during the treatment, and one patient (1.8%) had peripheral venous catheter phlebitis. There was no urinary tract infection, no hypokalemia and no hypernatremia in 48-72 hours following the procedure.
Conclusion: Forced diuresis with matched IV hydration is safe and reduces the risk of CI-AKI in real world high risk patients.
