Effects of Saline, Mannitol, and Furosemide on Acute Decreases in Renal Function Induced by Radiocontrast Agents

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., Acute decreases in renal function induced by the administration of radiocontrast agents are an important cause of hospital-acquired renal insufficiency, which contributes to morbidity and mortality during hospitalization and to the incidence of chronic end-stage renal disease 1 – 4 . Although the pathogenesis of acute renal insufficiency induced by radiocontrast agents is not fully understood, it appears to be due to medullary ischemia caused by decreased renal blood flow resulting from an imbalance of vasodilative and vasoconstrictive factors 5 . Because procedures involving the use of radiocontrast agents are scheduled beforehand and their occurrence is therefore predictable, a variety of prophylactic approaches… © 1994, Massachusetts Medical Society. All rights reserved.