RenalGuard system in high-risk patients for contrast-induced acute kidney injury - 24/02/16
, Gabriella Visconti, MD a, Michael Donahue, MD a, Francesca De Micco, PhD a, Amelia Focaccio, MD a, Bruno Golia, MD a, Giuseppe Signoriello, PhD b, Carmine Ciardiello, PhD c, Elvira Donnarumma, PhD d, Gerolama Condorelli, MD, PhD eRésumé |
Background |
High urine flow rate (UFR) has been suggested as a target for effective prevention of contrast-induced acute kidney injury (CI-AKI). The RenalGuard therapy (saline infusion plus furosemide controlled by the RenalGuard system) facilitates the achievement of this target.
Methods |
Four hundred consecutive patients with an estimated glomerular filtration rate ≤30 mL/min per 1.73 m2 and/or a high predicted risk (according to the Mehran score ≥11 and/or the Gurm score >7%) treated by the RenalGuard therapy were analyzed. The primary end points were (1) the relationship between CI-AKI and UFR during preprocedural, intraprocedural, and postprocedural phases of the RenalGuard therapy and (2) the rate of acute pulmonary edema and impairment in electrolytes balance.
Results |
Urine flow rate was significantly lower in the patients with CI-AKI in the preprocedural phase (208 ± 117 vs 283 ± 160 mL/h, P < .001) and in the intraprocedural phase (389 ± 198 vs 483 ± 225 mL/h, P = .009). The best threshold for CI-AKI prevention was a mean intraprocedural phase UFR ≥450 mL/h (area under curve 0.62, P = .009, sensitivity 80%, specificity 46%). Performance of percutaneous coronary intervention (hazard ratio [HR] 4.13, 95% CI 1.81-9.10, P < .001), the intraprocedural phase UFR <450 mL/h (HR 2.27, 95% CI 1.05-2.01, P = .012), and total furosemide dose >0.32 mg/kg (HR 5.03, 95% CI 2.33-10.87, P < .001) were independent predictors of CI-AKI. Pulmonary edema occurred in 4 patients (1%). Potassium replacement was required in 16 patients (4%). No patients developed severe hypomagnesemia, hyponatremia, or hypernatremia.
Conclusions |
RenalGuard therapy is safe and effective in reaching high UFR. Mean intraprocedural UFR ≥450 mL/h should be the target for optimal CI-AKI prevention.
Le texte complet de cet article est disponible en PDF.Plan
Vol 173
P. 67-76 - mars 2016 Retour au numéro
Article précédent
- Renal failure in patients with ST-segment elevation acute myocardial infarction treated with primary percutaneous coronary intervention: Predictors, clinical and angiographic features, and outcomes
- John P. Vavalle, Sean van Diepen, Robert M. Clare, Judith S. Hochman, W. Douglas Weaver, Rajendra H. Mehta, Karen S. Pieper, Manesh R. Patel, Uptal D. Patel, Paul W. Armstrong, Christopher B. Granger, Renato D. Lopes
- Longer-term impact of cardiology e-consults
- Jason H. Wasfy, Sandhya K. Rao, Neil Kalwani, Melissa D. Chittle, Calvin A. Richardson, Kathleen M. Gallen, Eric M. Isselbacher, Alexandra B. Kimball, Timothy G. Ferris
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?