Diuresis-matched versus standard hydration in patients undergoing percutaneous cardiovascular procedures: meta-analysis of randomized clinical trials.
Acute kidney injury
Angiografía coronaria
Angioplastia
Contrast media
Coronary angiography
Lesión renal aguda
Medios de contraste yodado
Nefropatía inducida por contraste
Percutaneous coronary intervention
Journal
Revista espanola de cardiologia (English ed.)
ISSN: 1885-5857
Titre abrégé: Rev Esp Cardiol (Engl Ed)
Pays: Spain
ID NLM: 101587954
Informations de publication
Date de publication:
Oct 2023
Oct 2023
Historique:
received:
07
12
2022
accepted:
01
02
2023
medline:
4
10
2023
pubmed:
22
2
2023
entrez:
21
2
2023
Statut:
ppublish
Résumé
Contrast-associated acute kidney injury (CA-AKI) is a potential complication of procedures requiring administration of iodinated contrast medium. RenalGuard, which provides real-time matching of intravenous hydration with furosemide-induced diuresis, is an alternative to standard periprocedural hydration strategies. The evidence on RenalGuard in patients undergoing percutaneous cardiovascular procedures is sparse. We used a Bayesian framework to perform a meta-analysis of RenalGuard as a CA-AKI preventive strategy. We searched Medline, Cochrane Library and Web of Science for randomized trials of RenalGuard vs standard periprocedural hydration strategies. The primary outcome was CA-AKI. Secondary outcomes were all-cause death, cardiogenic shock, acute pulmonary edema, and renal failure requiring renal replacement therapy. A Bayesian random-effect risk ratio (RR) with corresponding 95% credibility interval (95%CrI) was calculated for each outcome. PROSPERO database number CRD42022378489. Six studies were included. RenalGuard was associated with a significant relative reduction in CA-AKI (median RR, 0.54; 95%CrI, 0.31-0.86) and acute pulmonary edema (median RR, 0.35; 95%CrI, 0.12-0.87). No significant differences were observed for the other secondary endpoints [all-cause death (RR, 0.49; 95%CrI, 0.13-1.08), cardiogenic shock (RR, 0.06; 95%CrI, 0.00-1.91), and renal replacement therapy (RR, 0.52; 95%CrI, 0.18-1.18)]. The Bayesian analysis also showed that RenalGuard had a high probability of ranking first for all the secondary outcomes. These results were consistent in multiple sensitivity analyses. In patients undergoing percutaneous cardiovascular procedures, RenalGuard was associated with a reduced risk of CA-AKI and acute pulmonary edema compared with standard periprocedural hydration strategies.
Identifiants
pubmed: 36801376
pii: S1885-5857(23)00055-5
doi: 10.1016/j.rec.2023.02.001
pii:
doi:
Substances chimiques
Diuretics
0
Contrast Media
0
Types de publication
Meta-Analysis
Journal Article
Langues
eng
spa
Sous-ensembles de citation
IM
Pagination
759-766Informations de copyright
Copyright © 2023. Published by Elsevier España, S.L.U.