Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico G. Rodolico-San Marco, University of Catania, Catania, Italy.
Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico G. Rodolico-San Marco, University of Catania, Catania, Italy.
Rev Esp Cardiol (Engl Ed). 2023 Oct;76(10):759-766. doi: 10.1016/j.rec.2023.02.001. Epub 2023 Feb 16.
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.
对比剂相关急性肾损伤（CA-AKI）是需要使用碘造影剂的介入程序的潜在并发症。RenalGuard 通过实时匹配静脉补液和速尿诱导的利尿，是标准围手术期补液策略的替代方案。在接受经皮心血管介入程序的患者中，RenalGuard 的证据很少。我们使用贝叶斯框架对 RenalGuard 作为 CA-AKI 预防策略进行了荟萃分析。
我们在 Medline、Cochrane 图书馆和 Web of Science 中搜索了 RenalGuard 与标准围手术期补液策略的随机试验。主要结局是 CA-AKI。次要结局为全因死亡、心源性休克、急性肺水肿和需要肾脏替代治疗的肾衰竭。计算了每个结局的贝叶斯随机效应风险比（RR）及其对应的 95%可信度区间（95%CrI）。PROSPERO 数据库编号 CRD42022378489。
纳入了 6 项研究。RenalGuard 与 CA-AKI（中位数 RR，0.54；95%CrI，0.31-0.86）和急性肺水肿（中位数 RR，0.35；95%CrI，0.12-0.87）的相对减少显著相关。对于其他次要终点，没有观察到显著差异[全因死亡（RR，0.49；95%CrI，0.13-1.08）、心源性休克（RR，0.06；95%CrI，0.00-1.91）和肾脏替代治疗（RR，0.52；95%CrI，0.18-1.18）]。贝叶斯分析还表明，RenalGuard 在所有次要结局中都有很大可能排名第一。这些结果在多次敏感性分析中是一致的。
在接受经皮心血管介入程序的患者中，与标准围手术期补液策略相比，RenalGuard 与 CA-AKI 和急性肺水肿的风险降低相关。
