Prevention

Avoid

• furosemide ^a
• mannitol   ^d
• metformin ^d

Why?

• Furosemide increases the risk of developing acute renal dysfunction in patients with chronic renal insufficiency
• Mannitol has no clear effect on preventing acute renal dysfunction.

Using furosemide increases the risk of acute renal dysfunction following contrast media studies.

Patient	Treatment	Comparison	Outcome	CER	RRR (95% CI)	NNH (95% CI)
chronic renal insufficiency undergoing contrast study a	furosemide and 0.45% saline infusion	0.45% saline infusion	acute renal dysfunction at 48 hours	11%	-270% (-1100% to -16%)	3 (2 to 14)