title: Additional furosemide treatment beyond saline hydration for the prevention of contrast-induced nephropathy: a meta-analysis of randomized controlled trials.
abstract: OBJECTIVE
  There have been conflicting results on the clinical utility of furosemide in preventing contrast-induced nephropathy (CIN). This study aimed to elucidate the effect of additional furosemide treatment beyond saline hydration on CIN post radiologic procedures by a meta-analysis of randomized controlled trials (RCTs).
  
  
  METHODS
  The Medline, EMBASE, and Cochrane databases were systematically searched. Two reviewers independently determined the eligibility of studies that randomly assigned patients undergoing radiologic procedure to receive additional peri-procedural furosemide injection or intravenous saline hydration alone. Combined results were presented as risk ratios (RR) with 95% confidence intervals (CI) by random-effect models.
  
  
  RESULTS
  We identified 5 RCTs including 1330 patients. Of them 659 received peri-procedural furosemide injection in addition to saline hydration, and 671 only received intravenous saline hydration (the control). Relatively small total number of dialysis events and heart failure events were reported in the included studies (n = 18 across 5 trials, n = 24 across 3 trials, respectively). Compared to the control, additional furosemide treatment did not significantly increase the incidence of CIN (RR = 1.18; 95% CI, 0.50-2.78; P = 0.71) and the risk of dialysis (RR = 1.03; 95% CI, 0.41-2.57; P = 0.95) post radiologic procedure. Furthermore, furosemide treatment appeared to decrease the occurrence of heart failure (RR = 0.35; 95% CI, 0.14-0.88; P = 0.02).
  
  
  CONCLUSIONS
  Peri-procedural furosemide treatment in addition to saline hydration did not provide significantly prophylactic effect on CIN after radiologic procedure. Nevertheless, the process seemed likely to decrease the risk of heart failure post saline hydration.
authors.affiliation: Departmen of Cardiology, The Second Hospital of Hebei Medical University No. 215 Hepingxi Road, Shijiazhuang 050000, Hebei Province, China.
authors.forename: Guoqiang
authors.initials: G
authors.lastname: Gu
authors.affiliation: Departmen of Neurology, The Second Hospital of Hebei Medical University No. 215 Hepingxi Road, Shijiazhuang 050000, Hebei Province, China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Departmen of Cardiology, The Second Hospital of Hebei Medical University No. 215 Hepingxi Road, Shijiazhuang 050000, Hebei Province, China.
authors.forename: Rui
authors.initials: R
authors.lastname: Lu
authors.affiliation: Departmen of Cardiology, The Second Hospital of Hebei Medical University No. 215 Hepingxi Road, Shijiazhuang 050000, Hebei Province, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Cui
keywords: Contrast-induced nephropathy; furosemide; meta-analysis; saline hydration