Original InvestigationPathogenesis and Treatment of Kidney DiseaseForced Euvolemic Diuresis With Mannitol and Furosemide for Prevention of Contrast-Induced Nephropathy in Patients With CKD Undergoing Coronary Angiography: A Randomized Controlled Trial
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Setting and Participants
Between May 1996 and October 2000, all consecutive patients referred for cardiac angiography at the University of Alberta Hospital (Edmonton, Alberta, Canada) were screened for eligibility. Inclusion criteria were age 21 years or older and established CKD, defined as serum creatinine level greater than 1.7 mg/dL in the week before the procedure and on the morning of the procedure before any study interventions occurred. All patients were clinically stable and undergoing elective procedures;
Results
During 4 years of active recruitment, 92 patients were enrolled in the study. Mean patient age was 64 ± 14 years, 23% were women, 37% had diabetes, 77% had hypertension, and 47% used oral furosemide. Mean serum creatinine level at baseline was 2.8 ± 1.6 mg/dL, and average estimated glomerular filtration rate was 27 ± 11 mL/min/1.73 m2. Most (72%) patients underwent only diagnostic coronary angiography. There were no clinically important or statistically significant differences between
Discussion
Forced euvolemic diuresis with saline, mannitol, and furosemide has a sound pathophysiological mechanistic basis,11, 12, 13, 14, 15, 16 and we hypothesized that it ought to be useful for preventing contrast-induced renal injury in high-risk patients undergoing coronary angiography. We tested this hypothesis in a randomized controlled trial, successfully achieved forced euvolemic diuresis, and found that our intervention strategy almost doubled rates of contrast-induced nephropathy. The
Acknowledgements
We thank Dr Ross Tsuyuki (Director), Paula Priest, Ruth Dupuit, and the staff at EPICORE Center (Edmonton, AB, Canada) for ensuring that the study was undertaken as carefully and rigorously as possible.
Support: This study was supported by peer-reviewed grants from the Alberta Heritage Foundation for Medical Research (AHFMR) and the University of Alberta Hospital Foundation. Dr Majumdar receives salary support from AHFMR (Health Scholar).
Financial Disclosure: None.
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2019, European Journal of RadiologyCitation Excerpt :In contrast, the European Society of Cardiology/European Association for Cardio-Thoracic Surgery guidelines suggest that “the implementation of high-dose statin before diagnostic catheterization should be considered as an additional preventive measure in patients without contraindications” [107]. Many other pharmacological agents have been studied, including ascorbic acid, calcium channel blockers, furosemide, prostaglandin analogs, endothelin agonists, adenosine antagonists, l-arginine, hypertonic mannitol, dopamine, and theophylline [108–110]. None of these treatments seem to be effective in the prevention of ICM-induced renal toxicity.
Originally published online as doi: 10.1053/j.ajkd.2009.03.024 on June 18, 2009.
Trial registration: www.ClinicalTrials.gov; study number: NCT00175227.