Contrast-Induced Acute Kidney Injury Prevention in Acute Heart Failure

The K-PROSE study is a randomized clinical investigation evaluating strategies to prevent contrast-induced acute kidney injury (CI-AKI) in patients hospitalized with acute heart failure and moderate renal dysfunction (eGFR 30-75 mL/min/1.73 m²). Patients requiring contrast-enhanced CT imaging are randomized to either standard intravenous saline hydration or a furosemide-based decongestion strategy. Renal function is assessed using serial measurements of creatinine and cystatin C, before and after contrast exposure. By comparing renal outcomes, congestion status, and safety profiles, this study aims to determine whether a decongestion-focused approach provides superior renal protection compared with conventional hydration in high-risk acute heart failure patients.

Inclusion Criteria: * Adults aged 20 years or older * Emergency department visit/hospitalization for acute heart failure with clinical evidence of congestion * Planned contrast-enhanced computed tomography during the index hospitalization * Baseline renal dysfunction defined as an estimated glomerular filtration rate (eGFR) of 30-75 mL/min/1.73 m² Exclusion Criteria: * Requirement for vasopressor therapy * Requirement for renal replacement therapy (dialysis) * Known allergy or hypersensitivity to furosemide * Ongoing acute coronary syndrome * Pregnant or breastfeeding women, or women of childbearing potential without a negative pregnancy test * Hyperkalemia (serum potassium \>5.5 mmol/L) * Uncorrected volume depletion or hyponatremia (serum sodium \