What is the role of forced diuresis in the treatment of acute kidney injury (AKI)?

Updated: Dec 24, 2020
  • Author: Biruh T Workeneh, MD, PhD, FASN; Chief Editor: Vecihi Batuman, MD, FASN  more...
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A study in 92 patients undergoing coronary angiography documented a significantly increased risk of contrast-induced nephropathy in patients who received forced euvolemic diuresis with saline, mannitol, and furosemide, compared with those who received saline hydration. [60] A systematic review and meta-analysis of mannitol administration for AKI prevention concluded that mannitol is in fact detrimental for contrast-induced nephropathy. [61]

However, studies of forced diuresis with matched controlled hydration have reported a decrease in the incidence of AKI. [62, 63, 64] These studies have used a device, the RenalGuard System (RenalGuard Solutions, Inc; Milford, MA) that matches saline infusion rates to the patient’s urine output by volume and time. The device is commercially available in Europe but is still under study in the United States. [65]

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