title: RenalGuard system in high-risk patients for contrast-induced acute kidney injury.
abstract: BACKGROUND
  High urine flow rate (UFR) has been suggested as a target for effective prevention of contrast-induced acute kidney injury (CI-AKI). The RenalGuard therapy (saline infusion plus furosemide controlled by the RenalGuard system) facilitates the achievement of this target.
  
  
  METHODS
  Four hundred consecutive patients with an estimated glomerular filtration rate ≤30 mL/min per 1.73 m(2) and/or a high predicted risk (according to the Mehran score ≥11 and/or the Gurm score >7%) treated by the RenalGuard therapy were analyzed. The primary end points were (1) the relationship between CI-AKI and UFR during preprocedural, intraprocedural, and postprocedural phases of the RenalGuard therapy and (2) the rate of acute pulmonary edema and impairment in electrolytes balance.
  
  
  RESULTS
  Urine flow rate was significantly lower in the patients with CI-AKI in the preprocedural phase (208 ± 117 vs 283 ± 160 mL/h, P < .001) and in the intraprocedural phase (389 ± 198 vs 483 ± 225 mL/h, P = .009). The best threshold for CI-AKI prevention was a mean intraprocedural phase UFR ≥450 mL/h (area under curve 0.62, P = .009, sensitivity 80%, specificity 46%). Performance of percutaneous coronary intervention (hazard ratio [HR] 4.13, 95% CI 1.81-9.10, P < .001), the intraprocedural phase UFR <450 mL/h (HR 2.27, 95% CI 1.05-2.01, P = .012), and total furosemide dose >0.32 mg/kg (HR 5.03, 95% CI 2.33-10.87, P < .001) were independent predictors of CI-AKI. Pulmonary edema occurred in 4 patients (1%). Potassium replacement was required in 16 patients (4%). No patients developed severe hypomagnesemia, hyponatremia, or hypernatremia.
  
  
  CONCLUSIONS
  RenalGuard therapy is safe and effective in reaching high UFR. Mean intraprocedural UFR ≥450 mL/h should be the target for optimal CI-AKI prevention.
authors.affiliation: Laboratory of Interventional Cardiology and Department of Cardiology, Clinica Mediterranea, Naples, Italy. Electronic address: carlobriguori@clinicamediterranea.it.
authors.forename: Carlo
authors.initials: C
authors.lastname: Briguori
authors.affiliation: Laboratory of Interventional Cardiology and Department of Cardiology, Clinica Mediterranea, Naples, Italy.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Visconti
authors.affiliation: Laboratory of Interventional Cardiology and Department of Cardiology, Clinica Mediterranea, Naples, Italy.
authors.forename: Michael
authors.initials: M
authors.lastname: Donahue
authors.affiliation: Laboratory of Interventional Cardiology and Department of Cardiology, Clinica Mediterranea, Naples, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: De Micco
authors.affiliation: Laboratory of Interventional Cardiology and Department of Cardiology, Clinica Mediterranea, Naples, Italy.
authors.forename: Amelia
authors.initials: A
authors.lastname: Focaccio
authors.affiliation: Laboratory of Interventional Cardiology and Department of Cardiology, Clinica Mediterranea, Naples, Italy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Golia
authors.affiliation: Department of Mental Health and Preventive Medicine, Second University of Naples, Naples, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Signoriello
authors.affiliation: HT MED, Pozzuoli, Naples, Italy.
authors.forename: Carmine
authors.initials: C
authors.lastname: Ciardiello
authors.affiliation: IRCCS SDN, Naples, Italy.
authors.forename: Elvira
authors.initials: E
authors.lastname: Donnarumma
authors.affiliation: Department of Cellular and Molecular Biology and Pathology, "Federico II" University of Naples, Naples, Italy.
authors.forename: Gerolama
authors.initials: G
authors.lastname: Condorelli
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced / Q000175:diagnosis / Q000517:prevention & control*; D000368:Aged; D000792:Angiography / Q000009:adverse effects*; D003287:Contrast Media / Q000009:adverse effects*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000601:surgery; D003404:Creatinine / Q000097:blood; D004232:Diuretics / Q000008:administration & dosage; D004338:Drug Combinations; D016503:Drug Delivery Systems / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D005665:Furosemide / Q000008:administration & dosage*; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D007552:Isotonic Solutions; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D012965:Sodium Chloride / Q000008:administration & dosage*; D014563:Urodynamics
chemical_list: D003287:Contrast Media; D004232:Diuretics; D004338:Drug Combinations; D007552:Isotonic Solutions; D012965:Sodium Chloride; D005665:Furosemide; D003404:Creatinine