Study: Furosemide-induced high urine output reduces risk of CIN

Furosemide-induced high urine output with matched hydration significantly reduced the risk of contrast-induced nephropathy (CIN) in patients with chronic kidney disease undergoing a coronary procedure, according to a new study.

The study, published in the January issue of Journal of the American College of Cardiology-Cardiovascular Interventions, investigated the effect of furosemide-forced diuresis and intravenous saline infusion matched with urine output, using a novel dedicated device designed for CIN prevention.

Investigators studied 170 consecutive patients with chronic kidney disease undergoing coronary procedures. Patients were randomly assigned to receive either furosemide with matched hydration (FMH) or to standard intravenous isotonic saline hydration (control group).

The FMH group received an initial 250-mL intravenous bolus of normal saline over 30 minutes followed by an intravenous bolus (0.5 mg/kg) of furosemide. Hydration infusion rate was automatically adjusted to precisely replace the patient’s urine output.

When a urine output rate >300 mL/h was obtained, patients underwent the coronary procedure. Matched fluid replacement was maintained during the procedure and for 4 hours post-treatment. The definition of CIN was a ≥25% or ≥0.5 mg/dL rise in serum creatinine over baseline.

Four (4.6%) patients in the FMH group developed CIN versus 15 (18%) patients in the control group. A lower incidence of cumulative in-hospital clinical complications was also observed in FMH-treated patients than in the control group (8% vs 18%). In the FMH group, no device- or therapy-related complications were observed.