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A prospective randomized trial of prevention measures in patients at high risk for contrast nephropathy

Results of the P.R.I.N.C.E. study

^a William Beaumont Hospital, Royal Oak, Michigan, USA
^* Henry Ford Health System, Detroit, Michigan, USA

View larger version (19K): [in a new window]   Figure 1 Mean individual change in serum creatinine at 48 h in the control group and the two subsets of the experimental group. IVF = intravenous 0.45 normal saline at 150 ml/h for 6 h with upward adjustment for urine flow rates greater than 150 ml/h (control group). F = furosemide 1 mg/kg intravenously up to 100 mg at the start of the procedure. D = intravenous dopamine 3 mcg/kg/min at the start of the procedure and continued for 6 h. M = mannitol 12.5 g in 250 ml of 5% dextrose infused at the start of the procedure over a 2-h period. p = 0.21 by analysis of variance.

View larger version (30K): [in a new window]   Figure 2 Change in postcontrast exposure serum creatinine at 48 h stratified by measured urine flow rate, n = 98 (to convert from mg/dl to µmol/liter, multiply by 88.4). p < 0.05 for comparison of 1st to 5th quintile.

View larger version (15K): [in a new window]   Figure 3 Rates of renal failure shown by multiple definitions of the end point stratified over the cutpoint of 150 ml/h of urine flow induced by a forced diuresis, n = 98. = Low UFR (150 ml/h); = High UFR (>150 ml/h). p < 0.05. 1 indicates >25% rise in serum creatinine; 2 indicates >50% rise in serum creatinine; 3 indicates >100% rise in serum creatinine; 4 indicates >1.0 mg/dl rise in serum creatinine; 5 indicates a peak creatinine of >5.0 mg/dl at 48 h or dialysis. UFR = urine flow rate.

View larger version (23K): [in a new window]   Figure 4 Regression of induced urine flow rate predicting resultant change in serum creatinine from baseline to that measured at 48 h in mg/dl, controlling for baseline renal function (to convert from mg/dl to µmol/liter, multiply by 88.4). This shows a relation between increasing urine flow rates in the first 24 h after contrast exposure and reduction in renal injury measured at 48 h that is independent of baseline renal function in all 98 aggregated participants, r = –0.36; F = 5.73; p = 0.005. Urine flow rate (ml/h), beta = –0.36; t = –3.33; p = 0.001. Baseline CrCl (ml/min), beta = 0.10; t = 0.93; p = 0.36.