Briguori C
Department of Cardiology, Clinica Mediterranea, Naples, Italy.
Minerva Cardioangiol. 2012 Jun;60(3):291-7.
Contrast-induced acute kidney injury (CI-AKI) predicts unfavorable outcomes. The use of the RenalGuard™® system, to create high urine output and fluid balancing, may be beneficial in preventing CI-AKI. The REMEDIAL II trial is a randomized, multicenter, investigator-driven trial addressing the prevention of CI-AKI in high risk patients. Consecutive patients with an estimated glomerular filtration rate (eGFR) ≤30 mL/min/1.73 m2 and/or a risk score ≥11 were randomly assigned to 1) sodium bicarbonate solution and N-acetylcysteine (NAC) (Control group) or 2) the RenalGuard therapy, that is, hydration with saline and NAC controlled by the RenalGuard System and furosemide (RenalGuard group). CI-AKI (defined as an increase of ≥0.3 mg/dL in the serum creatinine concentration at 48 hours after the procedure) occurred in 16/146 patients in the RenalGuard group (11%) and in 30/146 patients in the Control group (20.5%) (P=0.025; OR=0.47; 95% CI=0.24-0.92). Absolute changes in CyC at 24 hours (0.02±0.32 versus -0.08±0.26; P=0.002) and at 48 hours (0.12±0.42 versus -0.03±0.31; P=0.001), as well as the rate of in-hospital dialysis (4.1% versus 0.7%; P=0.056) were higher in the Control group. In conclusion, the RenalGuard therapy seems to be a promising new approach in preventing CI-AKI in high risk patients.
对比剂诱导的急性肾损伤（CI-AKI）预示着不良结局。使用RenalGuard™®系统以产生高尿量和维持液体平衡，可能有助于预防CI-AKI。REMEDIAL II试验是一项随机、多中心、研究者发起的试验，旨在探讨高危患者CI-AKI的预防。估算肾小球滤过率（eGFR）≤30 mL/min/1.73 m2和/或风险评分≥11的连续患者被随机分为1）碳酸氢钠溶液和N-乙酰半胱氨酸（NAC）组（对照组）或2）RenalGuard治疗组，即通过RenalGuard系统控制的生理盐水和NAC水化联合呋塞米治疗（RenalGuard组）。CI-AKI（定义为术后48小时血清肌酐浓度升高≥0.3 mg/dL）在RenalGuard组146例患者中有16例（11%）发生，在对照组146例患者中有30例（20.5%）发生（P = 0.025；OR = 0.47；95% CI = 0.24 - 0.92）。对照组在24小时（0.02±0.32对 -0.08±0.26；P = 0.002）和48小时（0.12±0.42对 -0.03±0.31；P = 0.001）时胱抑素C（CyC）的绝对变化以及住院透析率（4.1%对0.7%；P = 0.056）更高。总之，RenalGuard治疗似乎是预防高危患者CI-AKI的一种有前景的新方法。
