Accordingly, the use of loop diuretics for the treatment of CIN is not recommended. Loop diuretics may be effective in restoring fluid balance through diuresis [173, 176], but may negatively affect the outcome of AKI [172]. In the treatment of CIN, physicians should keep appropriate body fluid volume and consider hemodialysis JSH-23 manufacturer whenever necessary. Does fluid therapy prevent the progression

of kidney dysfunction in patients with CIN? Answer: Because an excessive increase in body fluid volume after the development of CIN is a risk factor for the progression of kidney dysfunction and an increase in mortality, we consider that the volume of fluid therapy may be determined after careful evaluation of body fluid volume. Fluid therapy is an essential procedure to improve and maintain circulatory hemodynamics in patients with sepsis or shock, but multicenter collaborative

studies of critically ill patients with AKI, including those with sepsis and CIN, have shown that an excessive increase in body fluid volume is an NCT-501 research buy independent risk factor for in-hospital mortality [177, 178]. An early introduction of hemodialysis to restore fluid balance resulted in a decrease in mortality. On the other hand, no significant relationship was observed between selleck chemicals llc body fluid volume and an improvement of kidney function. Accordingly, keeping patients appropriate body fluid should be monitored carefully to ensure that they are receiving appropriate fluid therapy based on the correct volume for the patient because an excessive increase in body fluid volume may increase the risk of death. Does the low-dose dopamine prevent the progression of kidney dysfunction in patients with CIN? Answer: We recommend not using low-dose dopamine for the treatment of CIN because it does not improve recovery from AKI. In a RCT, patients with AKI after PCI (assumed to include many patients with CIN) Rucaparib purchase were randomized to receive low-dose dopamine or saline alone, and the peak SCr level and the percentage of

patients requiring hemodialysis were significantly higher in the group receiving low-dose dopamine [179]. In a subsequent RCT of patients with AKI, including those with CIN, there was no difference between the low-dose dopamine and placebo groups in SCr levels and percentages of patients requiring hemodialysis [180]. In 2 meta-analyses and a systematic review of studies addressing the use of dopamine in the prevention and/or treatment of kidney dysfunction, including studies on the use of low-dose dopamine for the prevention of AKI, low-dose dopamine was not effective in preventing the development and exacerbation of AKI and decreasing the percentages of patients requiring hemodialysis [181–183]. A sub-analysis of patients with CIN revealed similar results [183]. In a cross-over study of patients with mild non-oliguric AKI, the effects of low-dose dopamine (increases in GFR and sodium excretion) disappeared in a short period of time [184].