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Available online 17 March 2023
Diuresis-matched versus standard hydration in patients undergoing percutaneous cardiovascular procedures: meta-analysis of randomized clinical trials
Diuresis inducida frente a hidratación combinada en pacientes sometidos a procedimientos cardiovasculares percutáneos: metanálisis de ensayos clínicos aleatorizados
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Giovanni Occhipinti, Claudio Laudani, Marco Spagnolo, Antonio Greco, Davide Capodanno
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dcapodanno@unict.it

Corresponding author:
Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico G. Rodolico–San Marco, University of Catania, Catania, Italy
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Received 07 December 2022. Accepted 01 February 2023
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Table 1. Main features of the included controlled trials
Table 2. Sensitivity analyses of prespecified outcomes
Table 3. Leave-one-out analysis
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Abstract
Introduction and objectives

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords:
Acute kidney injury
Contrast media
Coronary angiography
Percutaneous coronary intervention
Abbreviations:
CA-AKI
Resumen
Introducción y objetivos

La nefropatía inducida por contraste (NIC) es una potencial complicación de los procedimientos que requieren la administración de medio de contraste yodado. El RenalGuard, que suministra una adecuada hidratación combinada con diuresis inducida por furosemida, es una alternativa a las estrategias convencionales de hidratación. Según la literatura disponible, la evidencia sobre el RenalGuard no es concluyente, por lo que hemos realizado un metanálisis utilizando una construcción bayesiana.

Métodos

Se realizaron búsquedas en Medline, Cochrane Library y Web of Science de ensayos aleatorizados de RenalGuard frente a estrategias estándar de hidratación periprocedimiento. El objetivo primario fue el desarrollo de NIC. Los objetivos secundarios fueron muerte por cualquier causa, shock cardiogénico, edema agudo de pulmón (EAP) e insuficiencia renal que requería terapia de reemplazo renal. Para cada resultado se calculó un riesgo relativo (RR) con el correspondiente intervalo de credibilidad del 95% (ICr95%). Registro número CRD42022378489 en PROSPERO database.

Resultados

Se incluyeron 6 estudios. El RenalGuard se asoció con una reducción relativa significativa de NIC (mediana de RR=0,54; ICr95%, 0,31-0,86) y EAP (mediana de RR=0,35; 95%ICr, 0,12-0,87). No se observaron diferencias significativas para los otros parámetros secundarios [muerte por cualquier causa (RR=0,49; ICr95%, 0,13-1,08), shock cardiogénico (RR=0,06; ICr95%, 0,00-1,91), terapia de reemplazo renal (RR=0,52; ICr95%, 0,18-1,18)]. El análisis Bayesiano también mostró que el RenalGuard obtuvo una alta probabilidad de posicionarse primero con respecto a todos los objetivos secundarios. Estos resultados fueron consistentes en múltiples análisis de sensibilidad.

Conclusiones

En los pacientes sometidos a procedimientos cardiovasculares percutáneos, el RenalGuard se asoció con un menor riesgo de NIC y EAP.

Palabras clave:
Lesión renal aguda
Nefropatía inducida por contraste
Medios de contraste yodado
Angiografía coronaria
Angioplastia

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