scholarly journals Association of intra‐operative hypotension with acute kidney injury, myocardial injury and mortality in non‐cardiac surgery: A meta‐analysis

2019 ◽  
Vol 73 (10) ◽  
Author(s):  
Ran An ◽  
Qian-Yun Pang ◽  
Hong‐Liang Liu
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Myocardial Injury ◽  
Meta Analysis ◽  
Kidney Injury

scholarly journals Remote Ischemic Preconditioning to Prevent Acute Kidney Injury After Cardiac Surgery: A Meta-Analysis of Randomized Controlled Trials

2021 ◽  
Vol 8 ◽  
Author(s):  
Zigang Liu ◽  
Yongmei Zhao ◽  
Ming Lei ◽  
Guancong Zhao ◽  
Dongcheng Li ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Randomized Controlled Trials ◽  
Ischemic Preconditioning ◽  
Meta Analysis ◽  
Kidney Injury ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Subgroup Analyses ◽  
Meta Regression

Objective: Randomized controlled trials (RCTs) evaluating the influence of remote ischemic preconditioning (RIPC) on acute kidney injury (AKI) after cardiac surgery showed inconsistent results. We performed a meta-analysis to evaluate the efficacy of RIPC on AKI after cardiac surgery.Methods: Relevant studies were obtained by search of PubMed, Embase, and Cochrane's Library databases. A random-effect model was used to pool the results. Meta-regression and subgroup analyses were used to determine the source of heterogeneity.Results: Twenty-two RCTs with 5,389 patients who received cardiac surgery −2,702 patients in the RIPC group and 2,687 patients in the control group—were included. Moderate heterogeneity was detected (p for Cochrane's Q test = 0.03, I2 = 40%). Pooled results showed that RIPC significantly reduced the incidence of AKI compared with control [odds ratio (OR): 0.76, 95% confidence intervals (CI): 0.61–0.94, p = 0.01]. Results limited to on-pump surgery (OR: 0.78, 95% CI: 0.64–0.95, p = 0.01) or studies with acute RIPC (OR: 0.78, 95% CI: 0.63–0.97, p = 0.03) showed consistent results. Meta-regression and subgroup analyses indicated that study characteristics, including study design, country, age, gender, diabetic status, surgery type, use of propofol or volatile anesthetics, cross-clamp time, RIPC protocol, definition of AKI, and sample size did not significantly affect the outcome of AKI. Results of stratified analysis showed that RIPC significantly reduced the risk of mild-to-moderate AKI that did not require renal replacement therapy (RRT, OR: 0.76, 95% CI: 0.60–0.96, p = 0.02) but did not significantly reduce the risk of severe AKI that required RRT in patients after cardiac surgery (OR: 0.73, 95% CI: 0.50–1.07, p = 0.11).Conclusions: Current evidence supports RIPC as an effective strategy to prevent AKI after cardiac surgery, which seems to be mainly driven by the reduced mild-to-moderate AKI events that did not require RRT. Efforts are needed to determine the influences of patient characteristics, procedure, perioperative drugs, and RIPC protocol on the outcome.

scholarly journals Impact of Early versus Late Initiation of Renal Replacement Therapy in Patients with Cardiac Surgery-Associated Acute Kidney Injury: Meta-Analysis with Trial Sequential Analysis of Randomized Controlled Trials

2018 ◽  
Vol 2018 ◽  
pp. 1-13
Author(s):  
Jie Cui ◽  
Da Tang ◽  
Zhen Chen ◽  
Genglong Liu
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Sequential Analysis ◽  
Meta Analysis ◽  
Kidney Injury ◽  
Early Initiation ◽  
Trial Sequential Analysis ◽  
Initiation Time ◽  
Late Initiation ◽  
The Impact

Background. Previous studies have examined the effect of the initiation time of renal replacement therapy (RRT) in patients with cardiac surgery-associated acute kidney injury (CSA-AKI), but the findings remain controversial. The aim of this meta-analysis was to systematically and quantitatively compare the impact of early versus late initiation of RRT on the outcome of patients with CSA-AKI.Methods. Four databases (PubMed, the Cochrane Library, ISI Web of Knowledge, and Embase) were systematically searched from inception to June 2018 for randomized clinical trials (RCTs). Two investigators independently performed the literature search, study selection, data extraction, and quality evaluation. Meta-analysis and trial sequential analysis (TSA) were used to examine the impact of RRT initiation time on all-cause mortality (primary outcome). The Grading of Recommendations Assessment Development and Evaluation (GRADE) was used to evaluate the level of evidence.Results. We identified 4 RCTs with 355 patients that were eligible for inclusion. Pooled analyses indicated no difference in mortality for patients receiving early and late initiation of RRT (relative risk [RR] = 0.61, 95% confidence interval [CI] = 0.33 to 1.12). However, the results were not confirmed by TSA. Similarly, early RRT did not reduce the length of stay (LOS) in the intensive care unit (ICU) (mean difference [MD] = -1.04; 95% CI = -3.34 to 1.27) or the LOS in the hospital (MD = -1.57; 95% CI = -4.62 to 1.48). Analysis using GRADE indicated the certainty of the body of evidence was very low for a benefit from early initiation of RRT.Conclusion. Early initiation of RRT had no beneficial impacts on outcomes in patients with CSA-AKI. Future larger and more adequately powered prospective RCTs are needed to verify the benefit of reduced mortality associated with early initiation of RRT.Trial Registration. This trial is registered with PROSPERO registration number CRD42018084465, registered on 11 February 2018.

scholarly journals Urinary, Plasma, and Serum Biomarkers’ Utility for Predicting Acute Kidney Injury Associated With Cardiac Surgery in Adults: A Meta-analysis

2015 ◽  
Vol 66 (6) ◽  
pp. 993-1005 ◽  
Author(s):  
Julie Ho ◽  
Navdeep Tangri ◽  
Paul Komenda ◽  
Amit Kaushal ◽  
Manish Sood ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Meta Analysis ◽  
Kidney Injury ◽  
Serum Biomarkers

scholarly journals Risk factors for acute kidney injury after pediatric cardiac surgery: a meta-analysis

2021 ◽  
Author(s):  
Jef Van den Eynde ◽  
Boris Delpire ◽  
Xander Jacquemyn ◽  
Ismat Pardi ◽  
Hajar Rotbi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Meta Analysis ◽  
Kidney Injury ◽  
Pediatric Cardiac Surgery

Prevalence of acute kidney injury after cardiac surgery:A systematic review and meta-analysis on risk factors and different diagnostic criterias(AKIN,RIFLE,KDIGO)

2019 ◽  
Author(s):  
Alii Alidadii ◽  
Morteza Salarzaei ◽  
Fatem Parooe
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Meta Analysis ◽  
Kidney Injury ◽  
World Health ◽  
Cochrane Library ◽  
Common Symptom ◽  
Total Prevalence

Abstract Objective: This systematic review and meta-analysis aimed to determine the incidence and some of risk factors of AKI after cardiac surgery using all three diagnostic criteria (AKIN,RIFLE, and KIDGO).Method: We searched for published literature in the English language in MEDLINE via PubMed, EMBASETM via Ovid, The Cochrane Library, and Trip database. For literature published in other languages, we searched national databases (Magiran and SID) , KoreaMed and LILACS, and we searched OpenGrey (www.opengrey.eu/) and the World Health Organization Clinical Trials Registry (who.int/ictrp) for unpublished literature and ongoing studies.To ensure the literature saturation, the list of the included research references or the relevant reviews found by searching was studied(MS). The keywords used in the search strategy were Acute kidney injury,acute renal failure, creatinine,cardiac surgery,heart surgury, Coronary artery bypass grafting(CABG),valve replacement,RIFLE (risk, injury, failure, loss, end-stage renal disease) ,Acute Kidney Injury Network (AKIN),KDIGO (Kidney Disease: Improving Global Outcomes) , which were combined using the AND, OR, and NOT operators.Results: A total of 33298 patients who had undergone the cardiac surgery were studied. Based on the random effect model the total prevalence of AKI in 33298 patients undergone the heart surgery was 26.3% (95% confidence interval[CI]:26.1%,26.6%, I2=99.5%). the total prevalence of AKI in patients undergone cardiac surgery based on AKIN criteria was 21.6% (95% CI –21.2%, 22.1%,I2=98.5%) of whom 21.6% (95% CI-21.2%,22.1%,I2=98.5%) were classified as AKIN stage 1, whereas 3% (95% CI-2.7%%,3.4%%,I2=90.6%) were classified as AKIN stage 2, and 3.2% (95% CI-3.0%%,3.4%%,I2=97.2%) were classified as AKIN stage 3. the total prevalence of AKI in patients undergone cardiac surgery based on RIFLE criteria was 26.0%% (95% CI –25.6%, 26.5%,I2=99.4%). total prevalence of AKI in patients undergone cardiac surgery based on KDIGO criteria was 34.7% (95% CI –33.8%, 35.7%,I2=98.4%). the highest prevalence of AKI in patients undergone cardiac surgery was in Brazil 45.7% (95% CI –43.6%, 47.8%) based on 3 articles included followed by USA with a prevalence of 29.6%(95% CI –28.7%, 29.4%) based on 7 articles included, Uruguay with a prevalence of 36.1%(95% CI –35%, 37.2%) based on 1 article, Canada with a prevalence of 16.7%(95% CI –15.7%, 17.6%) based on 4 articles included and Italy with a prevalence of 10.6%(95% CI –9.8%, 11.3%) based on 3 articles included.Conclusion: AKI after cardiac surgery is a common symptom, although most often more severe in elderly patients. The prevalence of AKI after cardiac surgery based on KDIGO criteria was found to be higher than RIFLE and AKIN. The prevalence of AKI regardless of the definition used showed a decreasing trend from 2009 to 2019. Our findings pointed to the superiority of the KDIGO criterion over RIFLE and AKIN for diagnosing and evaluating AKI after cardiac surgery. However, the widespread acceptance of consensus definitions ( RIFLE and AKIN criteria) for AKI is still reflected in the studies. In order to progress further, establishment of a uniform definition for AKI seems necessary.

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