title: AKIGUARD (Acute Kidney Injury GUARding Device) trial: in-hospital and one-year outcomes.
abstract: OBJECTIVE
  Contrast-induced acute kidney injury (CIAKI) in patients with chronic kidney disease undergoing coronary angiography or percutaneous coronary intervention is a common iatrogenic complication associated with increased morbidity and mortality. This study compares sodium bicarbonate/isotonic saline/N-acetylcysteine/vitamin C prophylaxis (BS-NAC) against high-volume forced diuresis with matched hydration in CIAKI prevention.
  
  
  METHODS
  One-hundred and thirty-three consecutive patients undergoing coronary angiography or percutaneous coronary intervention with estimated glomerular filtration rate less than 60 mL/min/1.73m were randomized to the study group receiving matched hydration (MHG) or to the control group receiving BS-NAC. MHG received in vein (i.v.) 250 mL isotonic saline bolus, followed by a 0.5 mg/kg furosemide i.v. bolus to forced diuresis. A dedicated device automatically matched the isotonic saline i.v. infusion rate to the urinary output for 1 h before, during and 4 h after the procedure.
  
  
  RESULTS
  MHG had the lowest incidence of CIAKI (7 vs. 25%, P = 0.01), major adverse cardiac and cerebrovascular events at 1 year (7 vs. 32%, P < 0.01) and readmissions to cardiology/nephrology departments (8 vs. 25%, P = 0.03; hospitalization days 1.0 ± 3.8 vs. 4.9 ± 12.5, P = 0.01). Three months after the procedure the decrease in the estimated glomerular filtration rate was 0.02% for MHG versus 15% for the control group.
  
  
  CONCLUSIONS
  Matched hydration was more effective than BS-NAC in CIAKI prevention. One-year follow-up showed that matched hydration was associated also with limited chronic kidney disease progression, major adverse cardiac and cerebrovascular events and hospitalizations.
authors.affiliation: aCardiovascular and Thoracic Department, A.O.U. Città della Salute e della Scienza di Torino-Molinette bDepartment of Surgical Sciences, University of Torino cNephrology Department, A.O.U. Città della Salute e della Scienza di Torino-Molinette, Turin, Italy.
authors.forename: Tullio
authors.initials: T
authors.lastname: Usmiani
authors.forename: Alessandro
authors.initials: A
authors.lastname: Andreis
authors.forename: Carlo
authors.initials: C
authors.lastname: Budano
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Sbarra
authors.forename: Monica
authors.initials: M
authors.lastname: Andriani
authors.forename: Paolo
authors.initials: P
authors.lastname: Garrone
authors.forename: Anna Laura
authors.initials: AL
authors.lastname: Fanelli
authors.forename: Chiara
authors.initials: C
authors.lastname: Calcagnile
authors.forename: Laura
authors.initials: L
authors.lastname: Bergamasco
authors.forename: Luigi
authors.initials: L
authors.lastname: Biancone
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Marra
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000517:prevention & control*; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media / Q000009:adverse effects*; D017023:Coronary Angiography / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D005665:Furosemide / Q000627:therapeutic use; D005919:Glomerular Filtration Rate; D006801:Humans; D057194:Intention to Treat Analysis; D007558:Italy; D053208:Kaplan-Meier Estimate; D008297:Male; D062645:Percutaneous Coronary Intervention; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000601:surgery; D017693:Sodium Bicarbonate / Q000627:therapeutic use; D012965:Sodium Chloride / Q000627:therapeutic use
chemical_list: D003287:Contrast Media; D012965:Sodium Chloride; D005665:Furosemide; D017693:Sodium Bicarbonate; D003404:Creatinine