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Previous Volume 331:1416-1420 November 24, 1994 Number 21 Next

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ABSTRACT

Background Injections of radiocontrast agents are a frequent cause of acute decreases in renal function, occurring most often in patients with chronic renal insufficiency and diabetes mellitus.

Methods We prospectively studied 78 patients with chronic renal insufficiency (mean [±SD] serum creatinine concentration, 2.1 ±0.6 mg per deciliter [186 ±53 µmol per liter]) who underwent cardiac angiography. The patients were randomly assigned to receive 0.45 percent saline alone for 12 hours before and 12 hours after angiography, saline plus mannitol, or saline plus furosemide. The mannitol and furosemide were given just before angiography. Serum creatinine was measured before and for 48 hours after angiography, and urine was collected for 24 hours after angiography. An acute radiocontrast-induced decrease in renal function was defined as an increase in the base-line serum creatinine concentration of at least 0.5 mg per deciliter (44 µmol per liter) within 48 hours after the injection of radiocontrast agents.

Results Twenty of the 78 patients (26 percent) had an increase in the serum creatinine concentration of at least 0.5 mg per deciliter after angiography. Among the 28 patients in the saline group, 3 (11 percent) had such an increase in serum creatinine, as compared with 7 of 25 in the mannitol group (28 percent) and 10 of 25 in the furosemide group (40 percent) (P = 0.05). The mean increase in serum creatinine 48 hours after angiography was significantly greater in the furosemide group (P = 0.01) than in the saline group.

Conclusions In patients with chronic renal insufficiency who are undergoing cardiac angiography, hydration with 0.45 percent saline provides better protection against acute decreases in renal function induced by radiocontrast agents than does hydration with 0.45 percent saline plus mannitol or furosemide.

Source Information

From New England Deaconess Hospital, Joslin Diabetes Center, and Harvard Medical School -- all in Boston. Presented at the 25th Annual Meeting of the American Society of Nephrology, Baltimore, November 15-18, 1992.

Address reprint requests to Dr. Solomon at Joslin Diabetes Center, 1 Joslin Pl., Boston, MA 02215.

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Prevention of Radiocontrast-Induced Renal Insufficiency
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N Engl J Med 1995; 332:1035-1036, Apr 13, 1995. Correspondence

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