Author + information
- Received August 25, 2016
- Revision received October 24, 2016
- Accepted November 3, 2016
- Published online February 20, 2017.
- Alessandro Putzu, MDa,
- Martina Boscolo Berto, MDb,
- Alessandro Belletti, MDc,
- Elena Pasotti, MDb,
- Tiziano Cassina, MDa,
- Tiziano Moccetti, MDb and
- Giovanni Pedrazzini, MDb,∗ ()
- aDepartment of Cardiovascular Anesthesia and Intensive Care, Cardiocentro Ticino, Lugano, Switzerland
- bDepartment of Cardiology, Cardiocentro Ticino, Lugano, Switzerland
- cDepartment of Anesthesia and Intensive Care, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milan, Italy
- ↵∗Address for correspondence:
Dr. Giovanni Pedrazzini, Fondazione Cardiocentro Ticino, Department of Cardiology, Via Tesserete 48, Lugano 6900, Switzerland.
Objectives The objective of this meta-analysis of randomized trials was to evaluate if the administration of furosemide with matched hydration using the RenalGuard System reduces contrast-induced acute kidney injury (CI-AKI) in patients undergoing interventional procedures.
Background CI-AKI is a serious complication following angiographic procedures and a powerful predictor of unfavorable early and long-term outcomes.
Methods Online databases were searched up to October 1, 2016, for randomized controlled trials. The primary outcome was the incidence of CI-AKI, and the secondary outcomes were need for renal replacement therapy, mortality, stroke, and adverse events.
Results A total of four trials (n = 698) published between 2011 and 2016 were included in the analysis and included patients undergoing percutaneous coronary procedures and transcatheter aortic valve replacement. RenalGuard therapy was associated with a lower incidence of CI-AKI compared with control treatment (27 of 348 [7.76%] patients vs. 75 of 350 [21.43%] patients; odds ratio [OR]: 0.31; 95% confidence interval [CI]: 0.19 to 0.50; I2 = 4%; p < 0.00001) and with a lower need for renal replacement therapy (2 of 346 [0.58%] patients vs. 12 of 348 [3.45%] patients; OR: 0.19; 95% CI: 0.05 to 0.76; I2 = 0%; p = 0.02). No major adverse events occurred in patients undergoing RenalGuard therapy.
Conclusions The main finding of this meta-analysis is that furosemide with matched hydration by the RenalGuard System may reduce the incidence of CI-AKI in high-risk patients undergoing percutaneous coronary intervention or transcatheter aortic valve replacement. However, further independent high-quality randomized trials should elucidate the effectiveness and safety of this prophylactic intervention in interventional cardiology.
- contrast-induced acute kidney injury
- interventional procedures
- invasive cardiology
- randomized trials
The authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Putzu and Boscolo Berto contributed equally to this study.
- Received August 25, 2016.
- Revision received October 24, 2016.
- Accepted November 3, 2016.
- American College of Cardiology Foundation