High‐volume forced diuresis with matched hydration using the RenalGuard System to prevent contrast‐induced nephropathy: A meta‐analysis of randomized trials

Abstract

Background Contrast‐induced nephropathy (CIN) is a well‐recognized complication of coronary angiography that is associated with poor outcomes. Several small randomized controlled trials (RCTs) have recently shown that in patients with chronic kidney disease (CKD), furosemide‐induced forced diuresis with matched hydration using the RenalGuard system can prevent its occurrence. However, individual studies have been underpowered and thus cannot show significant differences in major clinical endpoints. Hypothesis Forced diuresis with matched hydration using the RenalGuard system improves clinical outcomes in patients undergoing coronary angiography. Methods Scientific databases and websites were searched for relevant RCTs. The pooled risk ratios were calculated using random‐effects models. The primary endpoint was CIN, and the secondary endpoints were major adverse clinical events (MACEs) and the need for renal replacement therapy. Results Data from 3 trials including 586 patients were analyzed. High‐volume forced diuresis with matched hydration using the RenalGuard system decreased risk of CIN by 60% (risk ratio: 0.40, 95% confidence interval: 0.25 to 0.65, P < 0.001), MACE rate by 59%, and the need for renal replacement therapy by 78%, compared with the standard of care. Conclusions In patients with CKD undergoing coronary angiography, high‐volume forced diuresis with matched hydration using the RenalGuard system significantly reduces the risk of CIN, MACE rate, and the need for renal replacement therapy. Larger RCTs with sufficient power are needed to confirm these findings.

The Controversy of Contrast-Induced Nephropathy With Intravenous Contrast: What Is the Risk?

“…16 Several RCTs comparing intravenous fluids with no fluids, normal saline with half-normal saline solution, and different rates of saline solution infusion have shown reductions in AKI post-contrast exposure. [17][18][19][20] In these studies, the difference in AKI between the intervention and control groups could be due to contrast nephrotoxicity, although the ability of intravenous fluids to cause hemodilution of Scr level and correct hypotension makes this interpretation less certain.…”

Proper hydration in contrast-induced nephropathy among patients with acute myocardial infarction and cardiac insufficiency

“…Meanwhile the propotion of patients with Killip>I was less than 25% in 3 groups. Many studies have demonstrated that furosemide with matched hydration by the RenalGuard System seems to reduce the incidence of CIN [4,[23][24][25]. The hydration volume was 3,995±1,401 ml and 1,742±290 ml in the Renalguard and control group, respectively.…”

Hydration Strategies for Preventing Contrast-Induced Acute Kidney Injury: A Systematic Review and Bayesian Network Meta-Analysis

“…RenalGuard is a closed-loop fluid-management system, in which each volume of urine that enters the collection bag leads to the infusion of an equal volume of saline into the patient. Two meta-analyses [14,16] of RCTs concluded that the RenalGuard system significantly reduced the risk of CI-AKI and the need for renal replacement therapy in high-risk patients undergoing coronary angiography. Our rankogram analysis indicated that the RenalGuard system of guided hydration had the highest rank, with a SUCRA of 0.974.…”

“…Another RCT [12] concluded that the benefit of sodium bicarbonate was marginal relative to isotonic sodium chloride for preventing CI-AKI among critically ill patients. However, other studies indicated that the Renal-Guard System [13][14][15][16] and hemodynamic guided hydration [17][18][19] were safe and effective in preventing CI-AKI. Because of these apparently discrepant results, we conducted a network meta-analysis (NMA) to assess the effects of various hydration strategies on the occurrence of CI-AKI in an effort to identify the optimal strategy for prevention of CI-AKI.…”