Alessandro Putzu1, Martina Boscolo Berto2, Alessandro Belletti3, Elena Pasotti2, Tiziano Cassina1, Tiziano Moccetti2, Giovanni Pedrazzini4. 1. Department of Cardiovascular Anesthesia and Intensive Care, Cardiocentro Ticino, Lugano, Switzerland. 2. Department of Cardiology, Cardiocentro Ticino, Lugano, Switzerland. 3. Department of Anesthesia and Intensive Care, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milan, Italy. 4. Department of Cardiology, Cardiocentro Ticino, Lugano, Switzerland. Electronic address: giovanni.pedrazzini@cardiocentro.org.
Abstract
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. Copyright Â
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. Copyright Â
Authors: Yaron Arbel; Valentin Fuster; Usman Baber; Taye H Hamza; F S Siami; Michael E Farkouh Journal: Int J Cardiol Date: 2019-06-13 Impact factor: 4.164
Authors: Guy Witberg; Tali Steinmetz; Uri Landes; Rotem Pistiner Hanit; Hefziba Green; Shira Goldman; Hana Vaknin-Assa; Pablo Codner; Leor Perl; Benaya Rozen-Zvi; Ran Kornowski Journal: JAMA Netw Open Date: 2021-03-01