Novel Technique Prevents Contrast-Induced Acute Kidney Injury

Abstract

RenalGuard, a new physiologic therapy that washes contrast through the kidney rapidly, was superior to sodium bicarbonate and Nacetylcysteine (NAC) in preventing contrast-induced acute kidney injury in high-risk patients. These results came from the randomized, multicenter, investigator-driven Renal Insuffi ciency After Contrast Media Administration Trial II (REMEDIAL II), which was conducted in Italy and published online before print by Circulation. “The results of the REMEDIAL II trial support the concept that the most important strategy to prevent contrastinduced acute kidney injury is an optimal increase in the urine fl ow rate without inducing fl uid imbalance,” said lead author Carlo Briguori, MD, PhD, Chief of the Laboratory of Interventional Cardiology at Clinica Mediterranea (Mediterranean Clinic) in Naples, Italy, in an interview. “This effect is reached by the RenalGuard system in almost all patients. By contrast, it is hardly reached by standard hydration.” In REMEDIAL II, which was carried out at four interventional cardiology centers in Italy between January 2009 and December 2010, 294 patients were randomized to receive sodium bicarbonate solution plus NAC at a high dose (the control group), or hydration with saline and NAC at a high dose plus a low dose of furosemide controlled by the RenalGuard system. Two patients, one from each group, did not undergo scheduled treatment, leaving 146 patients in each group for the fi nal analysis.