Pharmacological interventions for the prevention of renal injury in surgical patients: a systematic literature review and meta-analysis.
Acute Kidney Injury
/ prevention & control
Adrenergic alpha-2 Receptor Agonists
/ therapeutic use
Atrial Natriuretic Factor
/ therapeutic use
Calcium Channel Blockers
/ therapeutic use
Humans
Nitric Oxide Donors
/ therapeutic use
Postoperative Complications
/ prevention & control
Randomized Controlled Trials as Topic
Surgical Procedures, Operative
Vasoconstrictor Agents
/ therapeutic use
clinical outcome
kidney injury
pharmacological interventions
renal protection
surgery
systematic review
Journal
British journal of anaesthesia
ISSN: 1471-6771
Titre abrégé: Br J Anaesth
Pays: England
ID NLM: 0372541
Informations de publication
Date de publication:
01 2021
01 2021
Historique:
received:
23
03
2020
revised:
20
05
2020
accepted:
19
06
2020
pubmed:
24
8
2020
medline:
29
1
2021
entrez:
24
8
2020
Statut:
ppublish
Résumé
The aim of this systematic review was to summarise the results of randomised controlled trials (RCTs) that have evaluated pharmacological interventions for renoprotection in people undergoing surgery. Searches were conducted to update a previous review using the Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE to August 23, 2019. RCTs evaluating the use of pharmacological interventions for renal protection in the perioperative period were included. The co-primary outcome measures were 30-day mortality and acute kidney injury (AKI). Pooled effect estimates were expressed as risk ratios (RRs) (95% confidence intervals). We included 228 trials enrolling 56 047 patients. Twenty-three trials were considered to be at low risk of bias across all domains. Atrial natriuretic peptides (14 trials; n=2207) reduced 30-day mortality (RR: 0.63 [0.41, 0.97]) and AKI events (RR: 0.43 [0.33, 0.56]) without heterogeneity. These effects were consistent across cardiac surgery and vascular surgery subgroups, and in sensitivity analyses restricted to studies at low risk of bias. Inodilators (13 trials; n=2941) reduced mortality (RR: 0.71 [0.53, 0.94]) and AKI events (RR: 0.65 [0.50, 0.85]) in the primary analysis and in cardiac surgery cohorts. Vasopressors (4 trials; n=1047) reduced AKI (RR: 0.56 [0.36, 0.86]). Nitric oxide donors, alpha-2-agonists, and calcium channel blockers reduced AKI in primary analyses, but not after exclusion of studies at risk of bias. Overall, assessment of the certainty of the effect estimates was low. There are multiple effective pharmacological renoprotective interventions for people undergoing surgery.
Sections du résumé
BACKGROUND
The aim of this systematic review was to summarise the results of randomised controlled trials (RCTs) that have evaluated pharmacological interventions for renoprotection in people undergoing surgery.
METHODS
Searches were conducted to update a previous review using the Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE to August 23, 2019. RCTs evaluating the use of pharmacological interventions for renal protection in the perioperative period were included. The co-primary outcome measures were 30-day mortality and acute kidney injury (AKI). Pooled effect estimates were expressed as risk ratios (RRs) (95% confidence intervals).
RESULTS
We included 228 trials enrolling 56 047 patients. Twenty-three trials were considered to be at low risk of bias across all domains. Atrial natriuretic peptides (14 trials; n=2207) reduced 30-day mortality (RR: 0.63 [0.41, 0.97]) and AKI events (RR: 0.43 [0.33, 0.56]) without heterogeneity. These effects were consistent across cardiac surgery and vascular surgery subgroups, and in sensitivity analyses restricted to studies at low risk of bias. Inodilators (13 trials; n=2941) reduced mortality (RR: 0.71 [0.53, 0.94]) and AKI events (RR: 0.65 [0.50, 0.85]) in the primary analysis and in cardiac surgery cohorts. Vasopressors (4 trials; n=1047) reduced AKI (RR: 0.56 [0.36, 0.86]). Nitric oxide donors, alpha-2-agonists, and calcium channel blockers reduced AKI in primary analyses, but not after exclusion of studies at risk of bias. Overall, assessment of the certainty of the effect estimates was low.
CONCLUSIONS
There are multiple effective pharmacological renoprotective interventions for people undergoing surgery.
Identifiants
pubmed: 32828488
pii: S0007-0912(20)30567-5
doi: 10.1016/j.bja.2020.06.064
pmc: PMC7844346
pii:
doi:
Substances chimiques
Adrenergic alpha-2 Receptor Agonists
0
Calcium Channel Blockers
0
Nitric Oxide Donors
0
Vasoconstrictor Agents
0
Atrial Natriuretic Factor
85637-73-6
Types de publication
Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
131-138Subventions
Organisme : British Heart Foundation
ID : RG/13/6/29947
Pays : United Kingdom
Informations de copyright
Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.
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