Pharmacological Strategies for the Prevention of Acute Kidney Injury Following Cardiac Surgery: An Overview of Systematic Reviews
Nishith N. Patel and Gianni D. AngeliniAffiliation:
Angelini, Level 7, Queen's Building, Bristol Heart Institute, Bristol Royal Infirmary, Marlborough Street, Bristol. United Kingdom. BS2 8HW.
Context: Post cardiac surgery acute kidney injury (AKI) is common, poorly understood and associated with a significant increase in morbidity and mortality.
Objectives: An overview of systematic reviews that have evaluated pharmacological agents for the prevention of AKI post cardiac surgery.
Data Sources: We searched electronic databases (PubMed and the Cochrane Database of Systematic Reviews) from inception to January 2014.
Study Selection: Systematic reviews of randomized controlled trials that have evaluated pharmacological agents for the prevention of AKI in adult patients undergoing cardiac surgery.
Data Analysis: Numbers needed to treat (NNT) or harm (NNH) were calculated from pooled events given in each meta-analysis. Primary outcome measures were defined as (i) mortality, (ii) need for renal replacement therapy (RRT), and (iii) acute kidney injury.
Results: Data from 7 systematic reviews evaluating 6 different pharmacological renoprotective agents were included. Dopamine, fenoldopam and N-acetylcysteine did not demonstrate any benefit in terms of mortality, need for RRT or incidence of AKI. Atrial natriuretic peptide reduced the need for RRT (NNT = 22 (95% CI: 13 to 73) and brain natriuretic peptide reduced the incidence of AKI (NNT = 11 (95% CI: 6 to 32), although both agents did not demonstrate any effect on mortality. Loop diuretics demonstrated increased incidence of AKI (NNH = 8 (95% CI: 5 to 15).
Conclusion: There is a paucity of effective renoprotective agents that can be used in adult cardiac surgical patients. There is an urgent need to develop novel renoprotective strategies.
Surgery, Cardiopulmonary Bypass, Kidney, Drugs, Prevention, Meta-Analysis, Overview.
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