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

JACC Cardiovasc Interv. 2017 Feb 27;10(4):355-363. doi: 10.1016/j.jcin.2016.11.006.

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.

Keywords: contrast-induced acute kidney injury; interventional procedures; invasive cardiology; meta-analysis; randomized trials.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • 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*

Substances

  • Contrast Media
  • Diuretics
  • Furosemide