I admit, I was shocked when I got to the end of the paper and found the authors had no disclosures – it seems nearly every study concerning a commercial product has someone on the payroll. Heck, the study is even registered with clinicaltrials.gov, and they didn’t change their protocol at all.
Anyway, this paper is in regards to the RenalGuard system, which is basically a closed-loop system that replaces a furosemide forced diuresis with normal saline. They compare this to “usual therapy”, which, for them, is sodium bicarbonate and n-acetylcysteine (NAC) for the prevention of contrast-induced nephropathy as a result of some iodixanol contrast load. Basically, they ran this system through a few patients who were at high-risk for CIN for ~5 hours around the time of their contrast procedure and tried to get their urine flow rate >300 mL/hr. When successful, those patients had significantly less CIN than the “usual therapy” group (10% vs. 20%).
So, seems like it works. There was more pulmonary edema (3 vs. 1) in the RenalGuard system, and more electrolyte abnormalities to replace, but this is a therapy that might yet have some utility. It may even be practical in an ED setting, to a limited extent.
“Renal Insufficiency After Contrast Media Administration Trial II (REMEDIAL II)”
www.ncbi.nlm.nih.gov/pubmed/21518686