Background: Contrast-induced nephropathy is common in patients with coronary angiography. Mechanistically, forced euvolemic diuresis with mannitol and furosemide ought to prevent contrast-induced nephropathy. Our objectives are to: (1) undertake a randomized trial testing this hypothesis, and (2) conduct a meta-analysis of our findings with 2 earlier studies.
Study Design: (1) Randomized allocation-concealed controlled trial with blinded ascertainment of outcomes, and (2) random-effects meta-analysis of 3 trials.
Setting & Participants: Single-center study of consenting adults with serum creatinine level greater than 1.7 mg/dL undergoing coronary angiography; patients unable to tolerate fluid challenge or receiving dialysis were excluded. Two previous trials had randomly assigned 159 patients.
Intervention: Forced euvolemic diuresis with saline, mannitol, and furosemide compared with saline hydration controls. All patients were pretreated with at least 500 mL of half-normal saline before angiography; during and 8 hours after, urine output was replaced milliliter per milliliter with half-normal saline.
Outcomes & Measurements: The primary outcome was contrast-induced nephropathy within 48 hours of the procedure, defined as a 0.5-mg/dL absolute or 25% relative increase in creatinine level.
Results: Overall, 92 patients were allocated to intervention (n = 46) or control (n = 46). Mean age was 64 +/- 14 (SD) years, 23% were women, 37% had diabetes, 47% used oral furosemide, mean creatinine level was 2.8 +/- 1.6 mg/dL, and most patients (72%) underwent diagnostic catheterization. Patients had a net positive fluid balance (389 +/- 958 mL for intervention versus 655 +/- 982 mL for controls; P = 0.2). Contrast-induced nephropathy occurred in 23 (50%) intervention patients versus 13 (28%) controls (relative risk, 1.77; 95% confidence interval, 1.03 to 3.05; P = 0.03; adjusted odds ratio, 3.73; P = 0.03). Within 48 hours, creatinine level had increased by 0.8 +/- 1.1 mg/dL with intervention versus 0.2 +/- 0.6 mg/dL for controls (P = 0.002). Overall, 11 (12%) patients died or required dialysis, with no difference according to allocation status (P = 0.5). Random-effects meta-analysis of published data (3 trials; 251 patients) suggests furosemide-based interventions lead to significant harm compared with hydration: pooled relative risk, 2.15; 95% confidence interval, 1.37 to 3.37; I(2) = 0%.
Limitations: Small single-center study that cannot determine whether harms were related to furosemide, mannitol, or a combination.
Conclusions: Forced euvolemic diuresis led to a significantly increased risk of contrast-induced nephropathy. This strategy should be abandoned, and our results suggest that oral furosemide therapy perhaps should be held before angiography.
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http://dx.doi.org/10.1053/j.ajkd.2009.03.024 | DOI Listing |
Cureus
December 2024
Diabetes and Endocrinology, Prabhath Diabetes Care Centre, Udupi, IND.
This meta-analysis investigates the potential of allopurinol to prevent contrast-induced nephropathy (CIN), a common and serious complication of percutaneous coronary intervention (PCI). CIN is particularly prevalent among high-risk populations, including patients with chronic kidney disease (CKD) or acute coronary syndrome (ACS), where the administration of contrast agents can exacerbate renal injury. Allopurinol, a xanthine oxidase inhibitor, is known for its dual action in reducing oxidative stress and uric acid production, positioning it as a promising therapeutic candidate to mitigate CIN.
View Article and Find Full Text PDFAngiology
January 2025
Department of Cardiology, University of Health Sciences Ankara City Hospital, Ankara, Turkey.
Contrast-induced nephropathy (CIN) poses a significant risk following primary percutaneous coronary intervention (pPCI) in patients with ST-Elevation Myocardial Infarction (STEMI). Magnesium (Mg²⁺) deficiency has been associated with renal dysfunction and cardiovascular diseases, yet its role in CIN development remains unclear. This study represents the first investigation exploring the relationship between Mg²⁺ levels and CIN in this context.
View Article and Find Full Text PDFJ Pineal Res
January 2025
Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Patients with chronic kidney disease (CKD) are at increased risk of acute kidney injury following exposure to contrast media. We evaluated the effect of melatonin, a potent antioxidant, as a protective strategy against contrast-induced acute kidney injury (CI-AKI), with a focus on molecular mechanisms. We randomized patients with an eGFR < 60 mL/min/1.
View Article and Find Full Text PDFBMC Cardiovasc Disord
January 2025
Department of Cardiology, Health Science University, Gazi Yaşargil Training and Research Hospital, Diyarbakır, 21070, Turkey.
Objective: The triglyceride glucose (TyG) index is a biomarker of insulin resistance and is associated with an increased risk of cardiovascular events. Contrast-induced nephropathy (CIN) is an important complication that causes poor outcomes in patients undergoing percutaneous coronary intervention (PCI). In this study, we aimed to investigate the relationship between the TyG index and CIN and mortality in patients who underwent PCI due to chronic total coronary occlusion (CTO).
View Article and Find Full Text PDFNarra J
December 2024
Department of Urology, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.
Contrast-induced acute kidney injury is a common complication marked by reduced kidney function within 48 hours of contrast administration. The aim of this study was to evaluate renal function, anatomy, and molecular changes at 24 hours, 48 hours, and 72 hours post-iodinated contrast media (ICM) administration. This true-experimental study used a post-test-only control group design.
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