Pharmacological interventions for the prevention of renal injury in surgical patients: a systematic literature review and meta-analysis
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.
Leicester National Institute for Health Research Biomedical Research Centre; British Heart Foundation (CH/12/1/29419 and AA18/3/34220).
CitationSuraj Pathak, Guido Olivieri, Walid Mohamed, Riccardo Abbasciano, Marius Roman, Sara Tomassini, Florence Lai, Marcin Wozniak, Gavin J. Murphy. Pharmacological interventions for the prevention of renal injury in surgical patients: a systematic literature review and meta-analysis, British Journal of Anaesthesia, Volume 126, Issue 1,2021,131-138, https://doi.org/10.1016/j.bja.2020.06.064.
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