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Rahman Shah, Sarah J Wood, Sajjad A Khan, Amina Chaudhry, M Rehan Khan, Mohamed S Morsy
BACKGROUND: Contrast-induced nephropathy (CIN) is a well-recognized complication of coronary angiography that is associated with poor outcomes. Several small randomized controlled trials (RCTs) have recently shown that in patients with chronic kidney disease (CKD), furosemide-induced forced diuresis with matched hydration using the RenalGuard system can prevent its occurrence. However, individual studies have been underpowered and thus cannot show significant differences in major clinical endpoints...
December 2017: Clinical Cardiology
Heyman Luckraz, Ramesh Giri, Benmjamin Wrigley, Anne-Marie Hennessy, Johann Nicholas, Alan Nevill
OBJECTIVES: As proof of concept, this prospective, observational study assessed the feasibility and early clinical outcomes of performing on-pump cardiac surgery with the RenalGuard system. BACKGROUND: Acute kidney injury (AKI) is reported in up to 30% of patients undergoing cardiac surgery and is a recognised independent predictor of both morbidity and mortality. Forced diuresis with the RenalGuard system reduces the incidence of AKI during percutaneous coronary intervention procedures but its use in cardiac surgery has not been explored...
2017: Open Heart
Stephanie Mattathil, Saad Ghumman, Jonathan Weinerman, Anand Prasad
BACKGROUND: Contrast-induced kidney injury (CI-AKI) following cardiovascular interventions results in increased morbidity and mortality. RenalGuard (RG) is a novel, closed loop system which balances volume administration with forced diuresis to maintain a high urine output. We performed a meta-analysis of the existing data comparing use of RG to conventional volume expansion. METHODS: Ten studies were found eligible, of which four were randomized controlled trials...
September 4, 2017: Journal of Interventional Cardiology
Jehan Z Bahrainwala, Amanda K Leonberg-Yoo, Michael R Rudnick
Contrast exposure in a population with chronic kidney disease (CKD) requires additional consideration given the risk of contrast-induced nephropathy (CIN) after exposure to iodinated contrast as well as systemic injury with exposure to gadolinium-based contrast agents (GBCA). Strategies to avoid CIN, and manage patients after exposure, including extracorporeal removal of contrast media, may differ among an advanced CKD population as compared to a general population. There is strong evidence to support the use of isotonic volume expansion and the lowest dose of low-osmolar or iso-osmolar contrast media possible to decrease CIN...
July 2017: Seminars in Dialysis
Christian M Beilstein, John R Prowle, Christopher J Kirwan
Purpose . Fluid therapy aimed at increasing urine output is a commonly employed strategy to prevent acute kidney injury (AKI) in critically ill patients with rhabdomyolysis. Automated fluid management has the potential to optimise urine output while avoiding fluid accumulation in rhabdomyolysis patients. Methods . In a single centre clinical service evaluation we compared a convenience sample of critically ill adults with rhabdomyolysis treated with automated fluid management using the RenalGuard® device to patients managed with manual fluid adjustment following our standard rhabdomyolysis protocol...
2016: International Journal of Nephrology
Gabriella Visconti, Amelia Focaccio, Michael Donahue, Bruno Golia, Antonio Marzano, Elvira Donnarumma, Bruno Ricciardelli, Lucio Selvetella, Luigi Marino, Carlo Briguori
AIMS: We aimed to assess whether the RenalGuard™ System is effective in preventing acute kidney injury (AKI) following transcatheter aortic valve implantation (TAVI). METHODS AND RESULTS: Forty-eight consecutive patients with chronic kidney disease (CKD) scheduled for TAVI were assigned to: 1) hydration with sodium bicarbonate solution (Control group), or 2) hydration with RenalGuard Therapy (RenalGuard group). Hypotension was defined as periprocedural mean blood pressure <55 mmHg...
April 8, 2016: EuroIntervention
Carlo Briguori, Gabriella Visconti, Michael Donahue, Francesca De Micco, Amelia Focaccio, Bruno Golia, Giuseppe Signoriello, Carmine Ciardiello, Elvira Donnarumma, Gerolama Condorelli
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 per 1.73 m(2) and/or a high predicted risk (according to the Mehran score ≥11 and/or the Gurm score >7%) treated by the RenalGuard therapy were analyzed...
March 2016: American Heart Journal
Marco Barbanti, Simona Gulino, Piera Capranzano, Sebastiano Immè, Carmelo Sgroi, Claudia Tamburino, Yohei Ohno, Guilherme F Attizzani, Martina Patanè, Rita Sicuso, Gerlando Pilato, Alessio Di Landro, Denise Todaro, Emanuela Di Simone, Andrea Picci, Giuliana Giannetto, Giuliano Costa, Wanda Deste, Daniela Giannazzo, Carmelo Grasso, Davide Capodanno, Corrado Tamburino
OBJECTIVES: The purpose of this study was to investigate the effect of the RenalGuard System (PLC Medical Systems, Milford, Massachusetts) on prevention of acute kidney injury (AKI) in patients undergoing transcatheter aortic valve replacement (TAVR). BACKGROUND: TAVR is associated with varying degrees of post-procedural AKI. The RenalGuard System is a dedicated device designed for contrast-induced AKI prevention. Whether this device is also effective in patients with severe aortic stenosis undergoing TAVR is unexplored...
October 2015: JACC. Cardiovascular Interventions
Yaron Arbel, Eyal Ben-Assa, Amir Halkin, Gad Keren, Arie Lorin Schwartz, Ofer Havakuk, Eran Leshem-Rubinow, Maayan Konigstein, Arie Steinvil, Yigal Abramowitz, Ariel Finkelstein, Shmuel Banai
BACKGROUND: Acute kidney injury (AKI) is observed in up to 41% of patients undergoing transcatheter aortic valve implantation (TAVI) and is associated with increased risk for mortality. The aim of the present study is to evaluate whether furosemide-induced diuresis with matched isotonic intravenous hydration using the RenalGuard system reduces AKI in patients undergoing TAVI. METHODS/DESIGN: Reduce-AKI is a randomized sham-controlled study designed to examine the effect of an automated matched hydration system in the prevention of AKI in patients undergoing TAVI...
July 2, 2014: Trials
Gur P Kaushal, Sudhir V Shah
Treating or preventing AKI requires treating or preventing a rise in serum creatinine as well as the immediate and remote clinical consequences associated with AKI. Because a substantial number of patients with AKI progress to ESRD, identifying patients likely to progress and halting progression are important goals for treating AKI. Many therapies for AKI are being developed, including RenalGuard Therapy, which aims to maintain high urine output; α-melanocyte-stimulating hormone, with anti-inflammatory and antiapoptotic activities; alkaline phosphatase, which detoxifies proinflammatory substances; novel, small interfering RNA, directed at p53 activation; THR-184, a peptide agonist of bone morphogenetic proteins; removal of catalytic iron, important in free-radical formation; and cell-based therapies, including mesenchymal stem cells in vivo and renal cell therapy in situ...
May 2014: Journal of the American Society of Nephrology: JASN
Richard Solomon
Kidney injury following the administration of iodinated contrast media occurs particularly in patients with reduced kidney and cardiac function and when large doses of contrast are used. There is little compelling evidence that vasodilators and anti-oxidants prevent this injury. Most prevention trials have employed intravenous volume loading as a central strategy. However, the success of this approach depends upon maintaining euvolemia while producing a vigorous diuresis. A novel strategy for maintaining euvolemia and inducing a vigorous diuresis has been developed using the RenalGuard system...
January 2014: Journal of Cardiology
C Briguori
Contrast-induced acute kidney injury (CI-AKI) predicts unfavorable outcomes. The use of the RenalGuard™® system, to create high urine output and fluid balancing, may be beneficial in preventing CI-AKI. The REMEDIAL II trial is a randomized, multicenter, investigator-driven trial addressing the prevention of CI-AKI in high risk patients. Consecutive patients with an estimated glomerular filtration rate (eGFR) ≤30 mL/min/1.73 m2 and/or a risk score ≥11 were randomly assigned to 1) sodium bicarbonate solution and N-acetylcysteine (NAC) (Control group) or 2) the RenalGuard therapy, that is, hydration with saline and NAC controlled by the RenalGuard System and furosemide (RenalGuard group)...
June 2012: Minerva Cardioangiologica
Mohammad G Saklayen
No abstract text is available yet for this article.
January 17, 2012: Annals of Internal Medicine
Carlo Briguori
No abstract text is available yet for this article.
September 30, 2013: International Journal of Cardiology
Jean-Francois Dorval, Simon R Dixon, Richard B Zelman, Charles J Davidson, Robert Rudko, Frederic S Resnic
BACKGROUND: Contrast-induced nephropathy (CIN) is a frequent complication following angiographic procedures with significant impact on healthcare costs, and long-term outcomes. Multiple reno-protective strategies have been studied but few have shown benefit in prospective randomized studies beyond limiting the exposure to iodinated contrast and adequate intravenous. We studied the performance and safety of a novel system designed to achieve precise real-time high volume fluid balance using a closed loop hydration monitoring and infusion system...
June 20, 2013: International Journal of Cardiology
Carlo Briguori, Gabriella Visconti, Amelia Focaccio, Flavio Airoldi, Marco Valgimigli, Giuseppe Massimo Sangiorgi, Bruno Golia, Bruno Ricciardelli, Gerolama Condorelli
BACKGROUND: The RenalGuard System, which creates high urine output and fluid balancing, may be beneficial in preventing contrast-induced acute kidney injury. METHODS AND RESULTS: 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(-1) · 1...
September 13, 2011: Circulation
Carlo Briguori, Gabriella Visconti, Bruno Ricciardelli, Gerolama Condorelli
AIMS: The combined prophylactic strategy of sodium bicarbonate plus N-acetylsyteine (NAC) seems to be effective in preventing contrast induced acute kidney injury (CI-AKI) in patients at low-to-medium risk. However, in patients at high and very high risk the rate of CI-AKI is still high. In this subset of patients the anticipated advantages of the RenalGuard(tm) System should be investigated. The RenalGuard(tm) System (PLC Medical Systems, Inc., Franklin, MA, USA) is a real-time measurement and real time matched fluid replacement device designed to accommodate the RenalGuard therapy, which is based on the theory that creating and maintaining a high urine output is beneficial by allowing a quick elimination of contrast media, and, therefore, reducing its toxic effects...
April 2011: EuroIntervention
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