Renal Insufficiency After Contrast Media Administration Trial II (REMEDIAL II) : RenalGuard System in High-Risk Patients for Contrast-Induced Acute Kidney Injury
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Media type:
E-Article
Title:
Renal Insufficiency After Contrast Media Administration Trial II (REMEDIAL II) : RenalGuard System in High-Risk Patients for Contrast-Induced Acute Kidney Injury
:
RenalGuard System in High-Risk Patients for Contrast-Induced Acute Kidney Injury
Description:
<jats:sec>
<jats:title>Background—</jats:title>
<jats:p>The RenalGuard System, which creates high urine output and fluid balancing, may be beneficial in preventing contrast-induced acute kidney injury.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Methods and Results—</jats:title>
<jats:p>
The Renal Insufficiency After Contrast Media Administration Trial II (REMEDIAL II) trial is a randomized, multicenter, investigator-driven trial addressing the prevention of contrast-induced acute kidney injury in high-risk patients. Patients with an estimated glomerular filtration rate ≤30 mL · min
<jats:sup>−1</jats:sup>
· 1.73 m
<jats:sup>−2</jats:sup>
and/or a risk score ≥11 were randomly assigned to sodium bicarbonate solution and N-acetylcysteine (control group) or hydration with saline and N-acetylcysteine controlled by the RenalGuard System and furosemide (RenalGuard group). The primary end point was an increase of ≥0.3 mg/dL in the serum creatinine concentration at 48 hours after the procedure. The secondary end points included serum cystatin C kinetics and rate of in-hospital dialysis. Contrast-induced acute kidney injury occurred in 16 of 146 patients in the RenalGuard group (11%) and in 30 of 146 patients in the control group (20.5%; odds ratio, 0.47; 95% confidence interval, 0.24 to 0.92). There were 142 patients (48.5%) with an estimated glomerular filtration rate ≤30 mL · min
<jats:sup>−1</jats:sup>
· 1.73 and 149 patients (51.5%) with only a risk score ≥11. Subgroup analysis according to inclusion criteria showed a similarly lower risk of adverse events (estimated glomerular filtration rate ≤30 mL · min
<jats:sup>−1</jats:sup>
· 1.73 m
<jats:sup>−2</jats:sup>
: odds ratio, 0.44; risk score ≥11: odds ratio, 0.45;
<jats:italic>P</jats:italic>
for interaction=0.97). Changes in cystatin C at 24 hours (0.02±0.32 versus −0.08±0.26;
<jats:italic>P</jats:italic>
=0.002) and 48 hours (0.12±0.42 versus 0.03±0.31;
<jats:italic>P</jats:italic>
=0.001) and the rate of in-hospital dialysis (4.1% versus 0.7%;
<jats:italic>P</jats:italic>
=0.056) were higher in the control group.
</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Conclusion—</jats:title>
<jats:p>RenalGuard therapy is superior to sodium bicarbonate and N-acetylcysteine in preventing contrast-induced acute kidney injury in high-risk patients.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Clinical Trial Registration—</jats:title>
<jats:p>
URL:
<jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="http://www.clinicaltrial.gov.">http://www.clinicaltrial.gov</jats:ext-link>
. Unique identifier: NCT01098032.
</jats:p>
</jats:sec>