title: Prevention of Contrast-Induced Acute Kidney Injury by Furosemide With Matched Hydration in Patients Undergoing Interventional Procedures: A Systematic Review and Meta-Analysis of Randomized Trials.
abstract: The objective of this meta-analysis of randomized trials was to evaluate if the administration of furosemide with matched hydration using the RenalGuard System reduces contrast-induced acute kidney injury (CI-AKI) in patients undergoing interventional procedures.
  
  
  
  CI-AKI is a serious complication following angiographic procedures and a powerful predictor of unfavorable early and long-term outcomes.
  
  
  
  Online databases were searched up to October 1, 2016, for randomized controlled trials. The primary outcome was the incidence of CI-AKI, and the secondary outcomes were need for renal replacement therapy, mortality, stroke, and adverse events.
  
  
  
  A total of four trials (n = 698) published between 2011 and 2016 were included in the analysis and included patients undergoing percutaneous coronary procedures and transcatheter aortic valve replacement. RenalGuard therapy was associated with a lower incidence of CI-AKI compared with control treatment (27 of 348 [7.76%] patients vs. 75 of 350 [21.43%] patients; odds ratio [OR]: 0.31; 95% confidence interval [CI]: 0.19 to 0.50; I2= 4%; p < 0.00001) and with a lower need for renal replacement therapy (2 of 346 [0.58%] patients vs. 12 of 348 [3.45%] patients; OR: 0.19; 95% CI: 0.05 to 0.76; I2= 0%; p = 0.02). No major adverse events occurred in patients undergoing RenalGuard therapy.
  
  
  
  The main finding of this meta-analysis is that furosemide with matched hydration by the RenalGuard System may reduce the incidence of CI-AKI in high-risk patients undergoing percutaneous coronary intervention or transcatheter aortic valve replacement. However, further independent high-quality randomized trials should elucidate the effectiveness and safety of this prophylactic intervention in interventional cardiology.
authors.affiliation: Department of Cardiovascular Anesthesia and Intensive Care, Cardiocentro Ticino, Lugano, Switzerland.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Putzu
authors.affiliation: Department of Cardiology, Cardiocentro Ticino, Lugano, Switzerland.
authors.forename: Martina
authors.initials: M
authors.lastname: Boscolo Berto
authors.affiliation: Department of Anesthesia and Intensive Care, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Belletti
authors.affiliation: Department of Cardiology, Cardiocentro Ticino, Lugano, Switzerland.
authors.forename: Elena
authors.initials: E
authors.lastname: Pasotti
authors.affiliation: Department of Cardiovascular Anesthesia and Intensive Care, Cardiocentro Ticino, Lugano, Switzerland.
authors.forename: Tiziano
authors.initials: T
authors.lastname: Cassina
authors.affiliation: Department of Cardiology, Cardiocentro Ticino, Lugano, Switzerland.
authors.forename: Tiziano
authors.initials: T
authors.lastname: Moccetti
authors.affiliation: Department of Cardiology, Cardiocentro Ticino, Lugano, Switzerland. Electronic address: giovanni.pedrazzini@cardiocentro.org.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Pedrazzini
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced / Q000401:mortality / Q000503:physiopathology / Q000517:prevention & control*; D016009:Chi-Square Distribution; D003287:Contrast Media / Q000009:adverse effects*; D004232:Diuretics / Q000009:adverse effects / Q000627:therapeutic use*; D019317:Evidence-Based Medicine; D005665:Furosemide / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D015994:Incidence; D007668:Kidney / Q000187:drug effects* / Q000503:physiopathology; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D065840:Protective Factors; D015641:Radiography, Interventional / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D016032:Randomized Controlled Trials as Topic; D017582:Renal Replacement Therapy; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000209:etiology; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D016896:Treatment Outcome; D014882:Water-Electrolyte Balance
chemical_list: D003287:Contrast Media; D004232:Diuretics; D005665:Furosemide
keywords: contrast-induced acute kidney injury; interventional procedures; invasive cardiology; meta-analysis; randomized trials