Effect of strict intraoperative blood pressure management strategy on postoperative acute kidney injury in non‐cardiac surgery: a meta‐analysis of randomised controlled trials

2021 ◽  
Author(s):  
Mengyun Tu ◽  
Shu Hong ◽  
Jia Lu ◽  
Yiheng Liu ◽  
Meng Deng
Keyword(s):  
Blood Pressure ◽  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Randomised Controlled Trials ◽  
Management Strategy ◽  
Meta Analysis ◽  
Kidney Injury ◽  
Controlled Trials ◽  
Pressure Management ◽  
Randomised Controlled

scholarly journals Pharmacological interventions for the prevention of contrast-induced acute kidney injury in high-risk adult patients undergoing coronary angiography: a systematic review and meta-analysis of randomised controlled trials

Open Heart ◽  
2019 ◽  
Vol 6 (1) ◽  
pp. e000864 ◽  
Author(s):  
Alexander J Sharp ◽  
Nishith Patel ◽  
Barney C Reeves ◽  
Gianni D Angelini ◽  
Francesca Fiorentino
Keyword(s):  
Systematic Review ◽  
Acute Kidney Injury ◽  
High Risk ◽  
Coronary Angiography ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Kidney Injury ◽  
Controlled Trials ◽  
High Dose ◽  
Randomised Controlled

ObjectiveQuantify the efficacy of strategies to prevent contrast-induced acute kidney injury (CI-AKI) in high-risk patients undergoing coronary angiography (CAG) with or without percutaneous coronary intervention (PCI).BackgroundCI-AKI remains a common problem. The renoprotective efficacy of existing pharmacological agents remains uncertain in high-risk populations.MethodsSystematic review and meta-analysis of randomised controlled trials (RCTs) to compare different strategies versus hydration in patients with chronic kidney disease (CKD) undergoing CAG±PCI. Primary outcome was incident CI-AKI. Fixed-effects meta-analyses estimated ORs, 95% CIs and heterogeneity.ResultsForty-eight RCTs were included. Seven pharmacological strategies were evaluated by multiple RCTs and 10 by one RCT each. These had varying risk of bias; >25% of trials were at high risk of performance bias. Five strategies significantly reduced the odds of CI-AKI: N-acetylcysteine (NAC) (27 trials, 5694 participants; OR=0.77, 95% CI 0.65 to 0.91, p=0.002, I2=36%), ascorbic acid (four trials, 759 participants; OR=0.59, 95% CI 0.39 to 0.89, p=0.01, I2=0%), statin (two trials, 3234 participants; OR=0.59, 95% CI 0.39 to 0.89, p=0.75, I2=0%), trimetazidine (two trials, 214 participants; OR=0.27, 95% CI 0.10 to 0.71, p=0.01, I2=0%) and nicorandil (two trials, 389 participants; OR=0.47, 95% CI 0.23 to 0.94, p=0.03, I2=52%). Theophylline had a similar, but non-significant, effect. A subgroup analysis found that the benefit of NAC was highest in patients requiring a high-contrast dose.ConclusionsSeveral drugs are renoprotective in patients with CKD undergoing CAG±PCI. The evidence is strongest for NAC. We recommend that NAC should be used when a high dose of contrast is anticipated.Trial registration numberPROSPERO registration CRD42014014704.Open Science Framework link: https://osf.io/vxg7d/?view_only=62bad0404b18405abd39ff2ead2575a8

scholarly journals Timing of renal replacement therapy for patients with acute kidney injury: A systematic review and meta-analysis

2020 ◽  
pp. 175114372090168
Author(s):  
Mark Andonovic ◽  
Richard Shemilt ◽  
Malcolm Sim ◽  
Jamie P Traynor ◽  
Martin Shaw ◽  
...  
Keyword(s):  
Systematic Review ◽  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Kidney Injury ◽  
Current Evidence ◽  
Controlled Trials ◽  
Randomised Controlled

Background Acute kidney injury is associated with high mortality, and the optimal time to start renal replacement therapy for acute kidney injury is unknown despite several randomised controlled trials on the subject. We performed a systematic review and meta-analysis to assess the effect of earlier initiation of renal replacement therapy for acute kidney injury on mortality and reported secondary outcomes. Methods All literature in databases EMBASE, MEDLINE and CENTRAL was searched from January 1970 to March 2019 using terms related to renal replacement therapy, timing and randomised controlled trials. All randomised controlled trials with 25 or more adult participants suffering from acute kidney injury comparing timing of renal replacement therapy were included. The results of the selected studies were pooled and expressed in terms of risk ratios (RR) and 95% confidence intervals (95% CI) using a random effects model. Results A total of 7008 records were identified; 94 were selected for full text review of which 10 were included in the final meta-analysis. The 10 studies comprised 1956 participants (989 ‘early’ group; 967 ‘late’ group) with 918 total deaths; the analysis demonstrated no significant differences between the ‘early’ and ‘late’ renal replacement therapy groups (RR = 0.98 (95% CI = 0.84, 1.15)) for mortality. No significant differences between groups were evident for period-wise mortality; dialysis dependence; recovery of renal function; length of intensive care unit or hospital stay; or number of renal replacement therapies, mechanical ventilation and vasopressor-free days. Conclusions Current evidence does not support the use of early renal replacement therapy for patients with acute kidney injury. Data from ongoing and future randomised controlled trials are required to strengthen the evidence base in the area.

scholarly journals Effect of N-acetylcysteine on prevention of contrast-associated acute kidney injury in patients with STEMI undergoing primary percutaneous coronary intervention: a systematic review and meta-analysis of randomised controlled trials

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e039009
Author(s):  
Zhaodong Guo ◽  
Jin Liu ◽  
Li Lei ◽  
Yan Xue ◽  
Liwei Liu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Acute Kidney Injury ◽  
Percutaneous Coronary Intervention ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Kidney Injury ◽  
Coronary Intervention ◽  
Controlled Trials ◽  
Percutaneous Coronary ◽  
Randomised Controlled

ObjectiveSeveral studies evaluating the preventive effect of N-acetylcysteine (NAC) on contrast-associated acute kidney injury (CA-AKI) among patients with ST segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI) have suggested inconsistent results and that a systematic review and meta-analysis should be performed.DesignSystematic review and meta-analysis.Data sourcesPubMed, MEDLINE, EMBASE, ClinicalTrials.gov and the Cochrane Central databases were searched from inception to 15 November 2019.Eligibility criteriaRandomised controlled trials assessing use of NAC compared with non-use of NAC (eg, placebo) in preventing CA-AKI in patients with STEMI following PPCI were included.Data synthesisRelative risks with 95% CIs were pooled using a random-effects model. Evidence level of conclusions was assessed by Cochrane GRADE measure.ResultsSeven trials including 1710 patients were identified. Compared with non-use of NAC, use of NAC significantly reduced the incidence of CA-AKI by 49% (risk ratio (RR) 0.51, 95% CI 0.31 to 0.82, p<0.01) and all-cause in-hospital mortality by 63% (RR 0.37, 95% CI 0.17 to 0.79, p=0.01). The estimated effects on the requirement for dialysis (RR 0.61, 95% CI 0.11 to 3.38, p=0.24) were not statistically significant. Trial sequential analysis confirmed the true positive of NAC in reducing risk of CA-AKI. Subgroup analyses suggested that the administration of NAC had greater benefits in patients with renal dysfunction and in those receiving oral administration and higher dosage of NAC.ConclusionsNAC intake reduces the risk of CA-AKI and all-cause in-hospital mortality in patients with STEMI undergoing PPCI. The estimated potential benefit of NAC in preventing dialysis was ambiguous, and further high-quality studies are needed.PROSPERO registration numberCRD42020155265.

scholarly journals Effect of low glycaemic index or load dietary patterns on glycaemic control and cardiometabolic risk factors in diabetes: systematic review and meta-analysis of randomised controlled trials

BMJ ◽  
2021 ◽  
pp. n1651 ◽  
Author(s):  
Laura Chiavaroli ◽  
Danielle Lee ◽  
Amna Ahmed ◽  
Annette Cheung ◽  
Tauseef A Khan ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Glycaemic Control ◽  
Dietary Patterns ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Density Lipoprotein ◽  
Glycaemic Index ◽  
Controlled Trials ◽  
Apo B ◽  
Randomised Controlled

Abstract Objective To inform the update of the European Association for the Study of Diabetes clinical practice guidelines for nutrition therapy. Design Systematic review and meta-analysis of randomised controlled trials. Data sources Medline, Embase, and the Cochrane Library searched up to 13 May 2021. Eligibility criteria for selecting studies Randomised controlled trials of three or more weeks investigating the effect of diets with low glycaemic index (GI)/glycaemic load (GL) in diabetes. Outcome and measures The primary outcome was glycated haemoglobin (HbA 1c ). Secondary outcomes included other markers of glycaemic control (fasting glucose, fasting insulin); blood lipids (low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), non-HDL-C, apo B, triglycerides); adiposity (body weight, BMI, waist circumference), blood pressure (systolic blood pressure (SBP) and diastolic blood pressure (DBP)), and inflammation (C reactive protein (CRP)). Data extraction and synthesis Two independent reviewers extracted data and assessed risk of bias. Data were pooled by random effects models. GRADE (grading of recommendations assessment, development, and evaluation) was used to assess the certainty of evidence. Results 29 trial comparisons were identified in 1617 participants with type 1 and 2 diabetes who were predominantly middle aged, overweight, or obese with moderately controlled type 2 diabetes treated by hyperglycaemia drugs or insulin. Low GI/GL dietary patterns reduced HbA 1c in comparison with higher GI/GL control diets (mean difference −0.31% (95% confidence interval −0.42 to −0.19%), P<0.001; substantial heterogeneity, I 2 =75%, P<0.001). Reductions occurred also in fasting glucose, LDL-C, non-HDL-C, apo B, triglycerides, body weight, BMI, and CRP (P<0.05), but not blood insulin, HDL-C, waist circumference, or blood pressure. A positive dose-response gradient was seen for the difference in GL and HbA 1c and for absolute dietary GI and SBP (P<0.05). The certainty of evidence was high for the reduction in HbA 1c and moderate for most secondary outcomes, with downgrades due mainly to imprecision. Conclusions This synthesis suggests that low GI/GL dietary patterns result in small important improvements in established targets of glycaemic control, blood lipids, adiposity, and inflammation beyond concurrent treatment with hyperglycaemia drugs or insulin, predominantly in adults with moderately controlled type 1 and type 2 diabetes. The available evidence provides a good indication of the likely benefit in this population. Study registration ClinicalTrials.gov NCT04045938 .

Green tea catechins and blood pressure: a systematic review and meta-analysis of randomised controlled trials

2014 ◽  
Vol 53 (6) ◽  
pp. 1299-1311 ◽  
Author(s):  
Saman Khalesi ◽  
Jing Sun ◽  
Nicholas Buys ◽  
Arash Jamshidi ◽  
Elham Nikbakht-Nasrabadi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Blood Pressure ◽  
Green Tea ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Tea Catechins ◽  
Green Tea Catechins ◽  
Randomised Controlled

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.

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