RenalGuard system in high-risk patients for contrast-induced acute kidney injury

Am Heart J. 2016 Mar;173:67-76. doi: 10.1016/j.ahj.2015.12.005. Epub 2015 Dec 17.

Abstract

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 m(2) 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.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Kidney Injury / chemically induced
  • Acute Kidney Injury / diagnosis
  • Acute Kidney Injury / prevention & control*
  • Aged
  • Angiography / adverse effects*
  • Contrast Media / adverse effects*
  • Coronary Artery Disease / diagnostic imaging
  • Coronary Artery Disease / surgery
  • Creatinine / blood
  • Diuretics / administration & dosage
  • Drug Combinations
  • Drug Delivery Systems / instrumentation*
  • Equipment Design
  • Female
  • Follow-Up Studies
  • Furosemide / administration & dosage*
  • Glomerular Filtration Rate / physiology
  • Humans
  • Isotonic Solutions
  • Male
  • Prospective Studies
  • Risk Factors
  • Sodium Chloride / administration & dosage*
  • Urodynamics

Substances

  • Contrast Media
  • Diuretics
  • Drug Combinations
  • Isotonic Solutions
  • Sodium Chloride
  • Furosemide
  • Creatinine