Acute renal failure: contrast media: adding furosemide or mannitol to a saline infusion did not reduce acute renal dysfunction

Clinical bottom line (level 1b)

  1. Patients with chronic renal insufficiency who had an injection of contrast media who receive furosemide and saline compared with saline were more likely to develop acute renal dysfunction (NNH = 3 at 48 hours) .
  2. There was no clear difference in the rate of acute renal dysfunction when patients were given mannitol and saline or saline.
Solomon et al: The New England Journal of Medicine 1994; 331: 1416-1420
Expires January 2003

The study

Unblinded ?concealed randomised trial with intention-to-treat
Setting: acute hospital, USA

78 patients (aged mean 63, 69% male) scheduled for cardiac angiography (usually for symptomatic coronary ischaemia) with creatinine > 140 µ mol/l or creatinine clearance < 60 ml/min.
Note:
  • The cardiologist selected the contrast media used: 32% received ionic contrast media. There was no difference in use between the two groups.
  • All patients received 0.45% saline iv at a rate of 1ml/kg/hr for 12 hours before and after angiography.


    • Control Group: (n = 28, 28 analysed): saline
    Experimental Group: (n = 25, 25 analysed): mannitol 25 mg iv during 60 minutes before angiography and saline
    Experimental Group: (n = 25, 25 analysed): furosemide 80 mg iv during 30 minutes before angiography and saline

    100% followed for 48 hours
    Outcome notes:
    • acute renal dysfunction : increase in serum creatinine = 44 µmol/l

    The evidence

    saline v. mannitol and saline
    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNH
    (95% CI)
    acute renal dysfunction weeks 3
    (10.71%)    		 7
    (28.0%)    		 -161%
    (-803% to 24%)    		 -17.29%
    (-38.29% to 3.72%)    		 6
    (NNT = 27 to infinity;
    NNH = 3 to infinity)

    saline v. furosemide and saline
    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNH
    (95% CI)
    acute renal dysfunction 48 hours 3
    (10.7%)    		 10
    (40.0%)    		 -273%
    (-1105% to -16%)    		 -29.29%
    (-51.65% to -6.92%)    		 3
    (2 to 14)

    Comments

    1. The study is too small to show any potential benefit or harm from adding mannitol to saline.

    Citation

    1. Solomon R, Werner C, Mann D, et al: Effects of saline, mannitol, and furosemide on acute decreases in renal function induced by radiocontrast agents. The New England Journal of Medicine 1994; 331: 1416-1420
    Search Terms: ?
    Contributor: Chris Ball and Musab Hayatli, October 1999
    Reviewer: Richard Koopmans

    Clinical Question.
    Patient chronic renal dysfunction receiving radiocontrast media
    Intervention or Exposure furosemide, mannitol
    Comparison saline
    Outcome acute renal dysfunction