Prevention of cardiac surgery-associated acute kidney injury: a systematic review and meta-analysis of non-pharmacological interventions.
Acute kidney injury
Cardiac surgery
Non-pharmacological interventions
Prevention
Journal
Critical care (London, England)
ISSN: 1466-609X
Titre abrégé: Crit Care
Pays: England
ID NLM: 9801902
Informations de publication
Date de publication:
12 09 2023
12 09 2023
Historique:
received:
17
07
2023
accepted:
06
09
2023
medline:
14
9
2023
pubmed:
13
9
2023
entrez:
12
9
2023
Statut:
epublish
Résumé
Cardiac surgery-associated acute kidney injury (CSA-AKI) is frequent. While two network meta-analyses assessed the impact of pharmacological interventions to prevent CSA-AKI, none focused on non-pharmacological interventions. We aim to assess the effectiveness of non-pharmacological interventions to reduce the incidence of CSA-AKI. We searched PubMed, Embase, Central and clinical trial registries from January 1, 2004 (first consensus definition of AKI) to July 1, 2023. Additionally, we conducted manual screening of abstracts of major anesthesia and intensive care conferences over the last 5 years and reference lists of relevant studies. We selected all randomized controlled trials (RCTs) assessing a non-pharmacological intervention to reduce the incidence of CSA-AKI, without language restriction. We excluded RCTs of heart transplantation or involving a pediatric population. The primary outcome variable was CSA-AKI. Two reviewers independently identified trials, extracted data and assessed risk of bias. Random-effects meta-analyses were conducted to calculate risk ratios (RRs) with 95% confidence intervals (CIs). We used the Grading of Recommendations Assessment, Development, and Evaluation to assess the quality of evidence. We included 86 trials (25,855 patients) evaluating 10 non-pharmacological interventions to reduce the incidence of CSA-AKI. No intervention had high-quality evidence to reduce CSA-AKI. Two interventions were associated with a significant reduction in CSA-AKI incidence, with moderate quality of evidence: goal-directed perfusion (RR, 0.55 [95% CI 0.40-0.76], I Two non-pharmacological interventions are likely to reduce CSA-AKI incidence, with moderate quality of evidence: goal-directed perfusion and remote ischemic preconditioning.
Sections du résumé
BACKGROUND
Cardiac surgery-associated acute kidney injury (CSA-AKI) is frequent. While two network meta-analyses assessed the impact of pharmacological interventions to prevent CSA-AKI, none focused on non-pharmacological interventions. We aim to assess the effectiveness of non-pharmacological interventions to reduce the incidence of CSA-AKI.
METHODS
We searched PubMed, Embase, Central and clinical trial registries from January 1, 2004 (first consensus definition of AKI) to July 1, 2023. Additionally, we conducted manual screening of abstracts of major anesthesia and intensive care conferences over the last 5 years and reference lists of relevant studies. We selected all randomized controlled trials (RCTs) assessing a non-pharmacological intervention to reduce the incidence of CSA-AKI, without language restriction. We excluded RCTs of heart transplantation or involving a pediatric population. The primary outcome variable was CSA-AKI. Two reviewers independently identified trials, extracted data and assessed risk of bias. Random-effects meta-analyses were conducted to calculate risk ratios (RRs) with 95% confidence intervals (CIs). We used the Grading of Recommendations Assessment, Development, and Evaluation to assess the quality of evidence.
RESULTS
We included 86 trials (25,855 patients) evaluating 10 non-pharmacological interventions to reduce the incidence of CSA-AKI. No intervention had high-quality evidence to reduce CSA-AKI. Two interventions were associated with a significant reduction in CSA-AKI incidence, with moderate quality of evidence: goal-directed perfusion (RR, 0.55 [95% CI 0.40-0.76], I
CONCLUSIONS
Two non-pharmacological interventions are likely to reduce CSA-AKI incidence, with moderate quality of evidence: goal-directed perfusion and remote ischemic preconditioning.
Identifiants
pubmed: 37700297
doi: 10.1186/s13054-023-04640-1
pii: 10.1186/s13054-023-04640-1
pmc: PMC10498585
doi:
Types de publication
Meta-Analysis
Systematic Review
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
354Informations de copyright
© 2023. BioMed Central Ltd., part of Springer Nature.
Références
Stat Med. 2002 Jun 15;21(11):1539-58
pubmed: 12111919
J Cardiothorac Vasc Anesth. 2017 Feb;31(1):291-308
pubmed: 27671216
Ann Thorac Surg. 2023 Jan;115(1):34-42
pubmed: 36549802
Ann Card Anaesth. 2004 Jan;7(1):44-50
pubmed: 17827561
J Thorac Cardiovasc Surg. 2014 Jan;147(1):376-82
pubmed: 23465551
Crit Care. 2013 Dec 13;17(6):R293
pubmed: 24330769
Int J Artif Organs. 2008 Feb;31(2):158-65
pubmed: 18311732
J Card Surg. 2021 Jun;36(6):2045-2052
pubmed: 33686738
J Thorac Cardiovasc Surg. 2018 Nov;156(5):1918-1927.e2
pubmed: 29778331
Anaesthesia. 2018 Aug;73(8):1019-1031
pubmed: 29682727
N Engl J Med. 2015 Oct 8;373(15):1397-407
pubmed: 26436208
Cardiorenal Med. 2013 Oct;3(3):178-199
pubmed: 24454314
Eur Heart J. 2019 Apr 1;40(13):1081-1088
pubmed: 30107514
J Extra Corpor Technol. 2012 Mar;44(1):10-4
pubmed: 22730858
Arch Intern Med. 2008 Mar 24;168(6):609-16
pubmed: 18362253
J Thorac Cardiovasc Surg. 2023 Feb;165(2):750-760.e5
pubmed: 33840474
Front Cardiovasc Med. 2021 Mar 18;8:601470
pubmed: 33816572
Circulation. 2009 Feb 3;119(4):495-502
pubmed: 19153273
Circulation. 2007 Sep 18;116(12):1386-95
pubmed: 17724264
Eur J Cardiothorac Surg. 2014 Dec;46(6):937-43
pubmed: 24482384
BMJ. 2008 Apr 26;336(7650):924-6
pubmed: 18436948
BMJ. 2021 Mar 29;372:n71
pubmed: 33782057
J Thromb Thrombolysis. 2019 Feb;47(2):179-185
pubmed: 30511259
J Extra Corpor Technol. 2015 Jun;47(2):90-4
pubmed: 26405356
J Am Soc Nephrol. 2022 Aug;33(8):1459-1470
pubmed: 35831022
Arterioscler Thromb Vasc Biol. 2006 Aug;26(8):1729-37
pubmed: 16741150
Anesth Analg. 2021 Aug 1;133(2):292-302
pubmed: 33684086
BMC Med Res Methodol. 2014 Dec 19;14:135
pubmed: 25524443
Perfusion. 2023 Apr;38(3):591-599
pubmed: 35125028
Braz J Cardiovasc Surg. 2020 Apr 01;35(2):211-224
pubmed: 32369303
JAMA. 2005 Apr 6;293(13):1653-62
pubmed: 15811985
Nephron. 2018;140(2):105-110
pubmed: 29945154
Circulation. 2007 Nov 27;116(22):2544-52
pubmed: 17998460
BMJ. 1997 Sep 13;315(7109):629-34
pubmed: 9310563
PLoS One. 2021 May 5;16(5):e0251129
pubmed: 33951113
Medicine (Baltimore). 2016 Dec;95(49):e5558
pubmed: 27930561
Circulation. 2009 May 12;119(18):2444-53
pubmed: 19398670
J Cardiothorac Vasc Anesth. 2023 Aug;37(8):1368-1376
pubmed: 37202231
Am J Cardiovasc Drugs. 2018 Feb;18(1):49-58
pubmed: 28819767
Nephrol Dial Transplant. 2008 Jun;23(6):1970-4
pubmed: 18178605
J Appl Physiol (1985). 2012 May;112(10):1727-34
pubmed: 22403352
Anesth Analg. 2022 Mar 1;134(3):592-605
pubmed: 34748518
Crit Care. 2004 Aug;8(4):R204-12
pubmed: 15312219
Nat Rev Nephrol. 2017 Nov;13(11):697-711
pubmed: 28869251
Biomed Res Int. 2016;2016:2985148
pubmed: 27419130
Anesthesiol Clin. 2019 Dec;37(4):729-749
pubmed: 31677688
BMJ. 2001 Jul 14;323(7304):101-5
pubmed: 11451790
J Cardiothorac Surg. 2011 Nov 02;6:147
pubmed: 22047038
Crit Care. 2011 Aug 10;15(4):R192
pubmed: 21831302
PLoS One. 2017 Nov 2;12(11):e0186772
pubmed: 29095881