Prevention of contrast nephropathy by furosemide with matched hydration: the MYTHOS (Induced Diuresis With Matched Hydration Compared to Standard Hydration for Contrast Induced Nephropathy Prevention) trial.
OBJECTIVE
This study investigated the effect of furosemide-forced diuresis and intravenous saline infusion matched with urine output, using a novel dedicated device designed for contrast-induced nephropathy (CIN) prevention.


BACKGROUND
CIN is a frequent cause of acute kidney injury associated with increased morbidity and mortality.


METHODS
A total of 170 consecutive patients with chronic kidney disease (CKD) undergoing coronary procedures were randomized to either furosemide with matched hydration (FMH group, n = 87) or to standard intravenous isotonic saline hydration (control group; n = 83). The FMH group received an initial 250-ml intravenous bolus of normal saline over 30 min followed by an intravenous bolus (0.5 mg/kg) of furosemide. Hydration infusion rate was automatically adjusted to precisely replace the patient's urine output. When a urine output rate >300 ml/h was obtained, patients underwent the coronary procedure. Matched fluid replacement was maintained during the procedure and for 4 h post-treatment. The definition of CIN was a ≥25% or ≥0.5 mg/dl rise in serum creatinine over baseline.


RESULTS
In the FMH group, no device- or therapy-related complications were observed. Four (4.6%) patients in the FMH group developed CIN versus 15 (18%) controls (p = 0.005). A lower incidence of cumulative in-hospital clinical complications was also observed in FMH-treated patients than in controls (8% vs. 18%; p = 0.052).


CONCLUSIONS
In patients with CKD undergoing coronary procedures, furosemide-induced high urine output with matched hydration significantly reduces the risk of CIN and may be associated with improved in-hospital outcome. (Induced Diuresis With Matched Hydration Compared to Standard Hydration for Contrast Induced Nephropathy Prevention [MYTHOS]; NCT00702728).
Centro Cardiologico Monzino, IRCCS, Department of Cardiovascular Sciences, University of Milan, Milan, Italy. giancarlo.marenzi@ccfm.it
Giancarlo
G
Marenzi
Cristina
C
Ferrari
Ivana
I
Marana
Emilio
E
Assanelli
Monica
M
De Metrio
Giovanni
G
Teruzzi
Fabrizio
F
Veglia
Franco
F
Fabbiocchi
Piero
P
Montorsi
Antonio L
AL
Bartorelli
D058186:Acute Kidney Injury / Q000139:chemically induced / Q000150:complications / Q000517:prevention & control*; D000368:Aged; D016001:Confidence Intervals; D003287:Contrast Media / Q000009:adverse effects*; D003404:Creatinine; D004232:Diuretics / Q000627:therapeutic use*; D005260:Female; D005440:Fluid Therapy; D005665:Furosemide / Q000627:therapeutic use*; D006801:Humans; D006875:Hydrotherapy / Q000379:methods*; D007674:Kidney Diseases / Q000139:chemically induced / Q000150:complications / Q000517:prevention & control; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D013223:Statistics as Topic; D018709:Statistics, Nonparametric; D013997:Time Factors
D003287:Contrast Media; D004232:Diuretics; D005665:Furosemide; D003404:Creatinine