Abstract
The accumulation of contrast media in the kidneys might lead to contrast-induced acute kidney injury. In this prospective, controlled observational study, we aimed to evaluate whether forced diuresis with matched isotonic intravenous hydration prevents the accumulation of contrast media in the kidneys of patients undergoing cardiac interventional procedures. We compared the intensity of contrast media accumulation as observed in nephrograms following these procedures, with and without peri-procedural controlled renal flushing. The study group consisted of 25 patients with impaired renal function treated with the RenalGuard system. The two control groups included 25 patients with normal kidney function and 8 patients with impaired renal function undergoing similar procedures with routine pre-procedural hydration, but without controlled renal flushing. Renal contrast media accumulation at the end of each procedure was scored by blinded cardiologists. The renal contrast accumulation score (CAS) in the study group was significantly lower, with a median score of 0 (IQR (0–0)) compared with 1.5 (IQR (1–2)) in the normal renal function control group and 1 (IQR (0.38–1.62)) in the impaired renal function control group (p < 0.001 and 0.003, respectively). In a multivariate analysis of CAS, RenalGuard treatment was independently associated with lower CAS compared to both control groups. In conclusion, RenalGuard use prevents renal contrast accumulation in patients with impaired renal function undergoing cardiac procedures with intra-arterial contrast media injection.
Highlights
Contrast-induced acute kidney injury (CI-AKI) is a known complication of coronary angiography and is associated with significantly unfavorable outcomes, including major cardiovascular events, the need for renal replacement therapy, prolonged hospitalization, and early death [1]
As RenalGuard use is the standard of care at our institution for patients with renal failure who undergo coronary angiography, PCI, or TAVI, we offered this treatment to all eligible patients, and those included in the second control group were only those who refused the treatment or were unable to receive it
Final analysis was performed on a total of 58 patients (74.4 years, 77% male), with 25 in the study group, 25 in the normal renal function control group, and 8 in the impaired renal function control group
Summary
Contrast-induced acute kidney injury (CI-AKI) is a known complication of coronary angiography and is associated with significantly unfavorable outcomes, including major cardiovascular events, the need for renal replacement therapy, prolonged hospitalization, and early death [1]. As there is no available effective therapy once acute kidney injury has occurred, the primary focus is to identify effective preventive therapies. Previous studies have shown that patients treated with the RenalGuard system showed lower incidence of CI-AKI [3,4,5]. Several studies have demonstrated that the volume of contrast media used during the procedure does not correlate with the incidence of CI-AKI [5,6,7]
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