EFFECTS OF SALINE, MANNITOL, AND FUROSEMIDE ON ACUTE DECREASES IN RENAL-FUNCTION INDUCED BY RADIOCONTRAST AGENTS

Background. Injections of radiocontrast agents are a frequent cause of acute decreases in renal function, occurring most often in patients w ith chronic renal insufficiency and diabetes mellitus. Methods. We pro spectively studied 78 patients with chronic renal insufficiency (mean [+/-SD] serum creatinine concentration, 2.1+/-0.6 mg per deciliter [18 6+/-53 mu mol per liter]) who underwent cardiac angiography. The patie nts 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 b efore angiography. Serum creatinine was measured before and far 48 hou rs after angiography, and urine was collected for 24 hours after angio graphy. 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 mu mol per liter) within 48 hour s after the injection of radiocontrast agents. Results. Twenty of the 78 patients (26 percent) had an increase in the serum creatinine conce ntration 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 (2 8 percent) and 10 of 25 in the furosemide group (40 percent) (P = 0.05 ). The mean increase in serum creatinine 48 hours after angiography wa s significantly greater in the furosemide group (P = 0.01) than in the saline group. Conclusions. In patients with chronic renal insufficien cy who are undergoing cardiac angiography, hydration with 0.45 percent saline provides better protection against acute decreases in renal fu nction induced by radiocontrast agents than does hydration with 0.45 p ercent saline plus mannitol or furosemide.