Prevention of Contrast-Induced Acute Kidney Injury by Furosemide With Matched Hydration in Patients Undergoing Interventional Procedures: A Systematic Review and Meta-Analysis of Randomized Trials

• Published in: JACC. Cardiovascular interventions 2017-02, Vol.10 (4), p.355
• Main Authors: Putzu, Alessandro, Boscolo Berto, Martina, Belletti, Alessandro, Pasotti, Elena, Cassina, Tiziano, Moccetti, Tiziano, Pedrazzini, Giovanni
• Format: Article
• Language: English
• Subjects: Acute Kidney Injury - chemically induced; Acute Kidney Injury - mortality; Acute Kidney Injury - physiopathology; Acute Kidney Injury - prevention & control; Chi-Square Distribution; Contrast Media - adverse effects; Diuretics - adverse effects; Diuretics - therapeutic use; Evidence-Based Medicine; Furosemide - adverse effects; Furosemide - therapeutic use; Humans; Incidence; Kidney - drug effects; Kidney - physiopathology; Odds Ratio; Percutaneous Coronary Intervention - adverse effects; Percutaneous Coronary Intervention - methods; Percutaneous Coronary Intervention - mortality; Protective Factors; Radiography, Interventional - adverse effects; Radiography, Interventional - methods; Radiography, Interventional - mortality; Randomized Controlled Trials as Topic; Renal Replacement Therapy; Risk Assessment; Risk Factors; Stroke - etiology; Transcatheter Aortic Valve Replacement - adverse effects; Transcatheter Aortic Valve Replacement - methods; Transcatheter Aortic Valve Replacement - mortality; Treatment Outcome; Water-Electrolyte Balance
• ISSN: 1876-7605
• DOI: 10.1016/j.jcin.2016.11.006

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. CI-AKI is a serious complication following angiographic procedures and a powerful predictor of unfavorable early and long-term outcomes. 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. 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; I  = 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; I  = 0%; p = 0.02). No major adverse events occurred in patients undergoing RenalGuard therapy. 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.