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8th World Nephrology Conference

Sao Paulo, Brazil

Carlo Briguori

Carlo Briguori

Clinica Mediterranea, Italy

Title: Renalguard system in high-risk patients for Contrast-induced acute kidney injure


Biography: Carlo Briguori


Background. High urine flow rate (UFR) has been suggested as a target for effective prevention of contrast-induced acute kidney injury (CI-AKI). The RenalGuard therapy (saline infusion plus furosemide controlled by the RenalGuard system) facilitates the achievement of this target. Methods. Four-hundred consecutive patients with an estimated glomerular filtration rate ≤30 ml/min/1.73 m2 and/or an high predicted risk (according to the Mehran score ≥11 and/or the Gurm score >7%) treated by the RenalGuard therapy were analyzed. The primary endpoints were 1) the relationship between CI-AKI and UFR during pre, intra, and post-procedural phase of the Renalguard therapy, and 2) the rate of acute pulmonary edema and impairment in electrolytes balance. Results. UFR was significantly lower in the patients with CI-AKI in the pre-procedural phase (208±117 versus 283±160 mL/h; p< 0.001) and in the intra-procedural phase (389±198 versus 483±225 mL/h; p = 0.009). The best threshold for CI-AKI prevention was a mean intraprocedural phase UFR ≥450 mL/h (area-under-curve = 0.62; p = 0.009; sensitivity 80%; specificity 46%). Performance of percutaneous coronary intervention (hazard ratio [HR] = 4.13; 95% confidence intervals [CI] 1.81-9.10; p <0.001), the intra-procedural phase UFR <450 mL/h (HR = 2.27; 95% CI 1.05-2.01; p = 0.012), and total furosemide dose >0.32 mg/kg (HR = 5.03; 95% CI 2.33-10.87; p< 0.001) were independent predictors of CI-AKI. Pulmonary edema occurred in 4 patients (1%). Potassium replacement was required in 16 (4%) patients. No patients developed severe hypomagnesemia, hyponatremia or hypernatremia. Conclusions. RenalGuard therapy is safe and effective in reaching high UFR. Mean intraprocedural UFR ≥450 mL/h should be the target for optimal CI-AKI prevention