Mattathil Stephanie, Ghumman Saad, Weinerman Jonathan, Prasad Anand
Department of Medicine, Division of Cardiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
J Interv Cardiol. 2017 Oct;30(5):480-487. doi: 10.1111/joic.12417. Epub 2017 Sep 4.
Contrast-induced kidney injury (CI-AKI) following cardiovascular interventions results in increased morbidity and mortality. RenalGuard (RG) is a novel, closed loop system which balances volume administration with forced diuresis to maintain a high urine output. We performed a meta-analysis of the existing data comparing use of RG to conventional volume expansion.
Ten studies were found eligible, of which four were randomized controlled trials. Of an aggregate sample size (N) of 1585 patients, 698 were enrolled in the four RCTs and 887 belonged to the remaining registries included in this meta-analysis. Primary outcomes included CI-AKI incidence and relative risk. Mortality, dialysis, and major adverse cardiovascular events (MACCE) were secondary outcomes. A random effects model was used and data were evaluated for publication bias.
RG was associated with significant risk reduction in CI-AKI compared to control (RR: 0.30, 95%CI: 0.18-0.50, P < 0.01). CI-AKI in RG was found to be 7.7% versus 23.6% in the control group (P < 0.01). Use of RG was associated with decreased mortality (RR: 0.43, 95%CI: 0.18-0.99, P = 0.05), dialysis (RR: 0.20, 95%CI: 0.06-0.61, P = 0.01), and MACCE (RR: 0.42, 95%CI: 0.27-0.65, P < 0.01) compared to control.
RG significantly reduces rates of CI-AKI compared to standard volume expansion and is also associated with decreased rates of death, dialysis, and MACCE.
心血管介入治疗后对比剂诱导的肾损伤（CI-AKI）会导致发病率和死亡率增加。RenalGuard（RG）是一种新型的闭环系统，可平衡容量输注与强制利尿以维持高尿量。我们对现有数据进行了荟萃分析，比较了RG与传统容量扩张的使用情况。
共筛选出10项符合条件的研究，其中4项为随机对照试验。在总计1585例患者的样本量（N）中，698例纳入了4项随机对照试验，887例属于本荟萃分析中纳入的其余登记研究。主要结局包括CI-AKI发病率和相对风险。死亡率、透析和主要不良心血管事件（MACCE）为次要结局。采用随机效应模型，并对数据进行发表偏倚评估。
与对照组相比，RG与CI-AKI风险显著降低相关（RR：0.30，95%CI：0.18-0.50，P＜0.01）。RG组的CI-AKI发生率为7.7%，而对照组为23.6%（P＜0.01）。与对照组相比，使用RG与死亡率降低（RR：0.43，95%CI：0.18-0.99，P = 0.05）、透析（RR：0.20，95%CI：0.06-0.61，P = 0.01）和MACCE（RR：0.42，95%CI：0.27-0.65，P＜0.01）相关。
与标准容量扩张相比，RG显著降低了CI-AKI的发生率，并且还与死亡、透析和MACCE发生率降低相关。
