Theophylline and aminophylline for prevention of acute kidney injury in neonates and children: a systematic review

ObjectiveTo compare the efficacy and safety of theophylline or aminophylline for prevention of acute kidney injury (AKI) in neonates and children.DesignSystematic review and meta-analysis with application of Grading of Recommendations, Assessment, Development and Evaluation system.Data sourcesPubMed/MEDLINE, Embase, Google Scholar and Cochrane renal group were searched from 1970 to May 2018.Eligibility criteriaRandomised clinical trials and quasi-randomised trials comparing the efficacy and safety of prophylactic theophylline or aminophylline for prevention of AKI in neonates and children were included. The primary outcomes were: incidence of AKI, serum creatinine levels and all-cause mortality.ResultsA total of nine trials were included in the qualitative synthesis. Six trials including 436 term neonates with birth asphyxia who received a single dose of theophylline were finally included in the meta-analysis. The pooled estimate showed 60% reduction in the incidence of AKI in neonates with severe birth asphyxia (RR: 0.40; 95% CI 0.3 to 0.54; heterogeneity: I2=0%) (moderate quality evidence), decrease in serum creatinine over days 2–5 (very low to low quality evidence) without significant difference in all-cause mortality (RR: 0.88; 95% CI 0.52 to 1.50; heterogeneity: I2=0%) (very low-quality evidence). A significant difference in the negative fluid balance, increase in GFR and decrease in urinary β2 microglobulin was seen in favour of theophylline.Conclusion and relevanceA single dose of prophylactic theophylline helps in prevention of AKI/severe renal dysfunction in term neonates with severe birth asphyxia (moderate quality evidence) without increasing the risk of complications and without affecting all-cause mortality (very low-quality evidence).Trial registration numberCRD 42017073600.

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SAT-006 Efficacy and Safety of High-volume Hemofiltration (HVHF) in patients with Septic Shock and Acute Kidney Injury: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Kidney International Reports ◽

10.1016/j.ekir.2020.02.010 ◽

2020 ◽

Vol 5 (3) ◽

pp. S2-S3

Author(s):

S. EDDING ◽

B.M. Cabral

Keyword(s):

Systematic Review ◽

Septic Shock ◽

Acute Kidney Injury ◽

Meta Analysis ◽

Kidney Injury ◽

High Volume ◽

Controlled Trials ◽

Efficacy And Safety ◽

Randomized Controlled ◽

High Volume Hemofiltration

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SO017EFFECT OF HIGH-CUTOFF DIALYSIS FOR ACUTE KIDNEY INJURY SECONDARY TO CAST NEPHROPATHY IN PATIENTS WITH MULTIPLE MYELOMA: A SYSTEMATIC REVIEW AND META-ANALYSIS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa139.so017 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Blanca Tarragon ◽

Nan Ye ◽

Martin Gallagher ◽

Shaundeep Sen ◽

Jose' M Portoles ◽

...

Keyword(s):

Systematic Review ◽

Multiple Myeloma ◽

Acute Kidney Injury ◽

Clinical Outcomes ◽

Observational Studies ◽

Meta Analysis ◽

Kidney Injury ◽

Controlled Trials ◽

Cast Nephropathy ◽

All Cause Mortality

Abstract Background and Aims The incidence of multiple myeloma (MM) is increasing. Abnormal secretion of serum free light chains (sFLC) can lead to cast nephropathy and severe acute kidney injury (AKI) requiring haemodialysis (HD), which is associated with increased morbidity and mortality. High cut-off (HCO) HD membranes demonstrate better sFLC clearance. However, their role in all-cause mortality and renal recovery remains uncertain. Method A systematic review and meta-analysis was performed examining all randomized controlled trials (RCTs) and observational studies assessing the effect of high cut-off HD compared to conventional HD on clinical outcomes of patients with MM complicated by cast nephropathy induced-severe AKI. Medline, EMBASE, and the Cochrane Central Register of Controlled Trials were searched until September 2019. The primary outcome was all-cause mortality at the end of the study. The secondary outcomes included all-cause mortality at 12 months, haemodialysis independence at 3, 6 and 12 months, biopsy-proven haematologic responses at 90 days and sFLC (kappa and lambda) reduction. Random effect models were used to pool relative risks (RR) with 95% conﬁdence intervals (CIs) for individual studies. Results The search identified 5 studies including 276 patients with a mean follow-up of 18.7 months. There were 2 RCTs and 3 retrospective cohort studies. Compared with patients treated with conventional HD, patients on HCO dialysis did not show survival benefits at 12 months (4 studies, 186 patients, RR 0.79; 95% CI 0.46-1.36), or at the end of the study (5 studies, 276 patients, RR 0.86; 95% CI 0.60-1.25). Although survival benefits at the end of study (3 studies, 88 patients, RR 0.64; 95% CI 0.45-0.90) were seen in observational studies, no differences in all-cause mortality was seen in RCTs (2 studies, 188 patients, RR 1.31; 95% CI 0.50-3.46). Likewise, although the pooled data from the observational studies demonstrated significantly higher rates of HD independence at 90 days (2 trials, 78 patients, RR 2.23; 95% CI 1.09-4.55), this difference disappeared when the data from RCTs were included to the analysis (4 studies, 266 patients, RR 1.28; 95% CI 0.95-1.73). There was no difference in HD Independence at 6 months (2 studies, 188 patients, RR 1.19; 95% CI 0.68-2.06), and 12 months (2 studies, 188 patients, RR 1.14; 95% CI 0.58-2.26) between these two therapies. Patients receiving HCO dialysis, however, had significantly better biopsy-proven haematologic response at 90 days by 40% (3 studies, 176 patients, RR 1,40; 95% CI 1.13-1.74) and a significantly higher kappa light chain reduction (2 studies, 188 patients, standardized mean difference (SMD) 2.37; 95% CI 1.99-2.75; I2 = 0%). Overall, the majority of the studies were of suboptimal quality and underpowered. Conclusion Current evidence from RCTs and observational studies suggest HCO dialysis provides haematological benefits but makes no significant improvement in all-cause mortality and renal outcomes, compared to conventional HD for patients with multiple myeloma associated cast nephropathy. However, there is a trend towards better renal outcomes, therefore further large-scale RCTs are needed to assess the effect of HCO dialysis on clinical outcomes in patients with multiple myeloma complicated by cast-nephropathy.

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Accelerated versus standard initiation of renal replacement therapy for critically ill patients with acute kidney injury: a systematic review and meta-analysis of RCT studies

Critical Care ◽

10.1186/s13054-020-03434-z ◽

2021 ◽

Vol 25 (1) ◽

Author(s):

Heng-Chih Pan ◽

Ying-Ying Chen ◽

I-Jung Tsai ◽

Chih-Chung Shiao ◽

Tao-Min Huang ◽

...

Keyword(s):

Systematic Review ◽

Acute Kidney Injury ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Critically Ill ◽

Critically Ill Patients ◽

Meta Analysis ◽

Kidney Injury ◽

All Cause Mortality ◽

Surgical Icu

Abstract Background Acute kidney injury (AKI) is a common yet possibly fatal complication among critically ill patients in intensive care units (ICU). Although renal replacement therapy (RRT) is an important supportive management for severe AKI patients, the optimal timing of RRT initiation for these patients is still unclear. Methods In this systematic review, we searched all relevant randomized controlled trials (RCTs) that directly compared accelerated with standard initiation of RRT from PUBMED, MEDLINE, EMBASE, and Cnki.net published prior to July, 20, 2020. We extracted study characteristics and outcomes of being free of dialysis, dialysis dependence and mortality. We rated the certainty of evidence according to Cochrane methods and the GRADE approach. Results We identified 56 published relevant studies from 1071 screened abstracts. Ten RCTs with 4753 critically ill AKI patients in intensive care unit (ICU) were included in this meta-analysis. In our study, accelerated and standard RRT group were not associated with all-cause mortality (log odds-ratio [OR]: − 0.04, 95% confidence intervals [CI] − 0.16 to 0.07, p = 0.46) and free of dialysis (log OR: − 0.03, 95% CI − 0.14 to 0.09, p = 0.65). In the subgroup analyses, accelerated RRT group was significantly associated with lower risk of all-cause mortality in the surgical ICU and for those who received continuous renal replacement therapy (CRRT). In addition, patients in these two subgroups had higher chances of being eventually dialysis-free. However, accelerated initiation of RRT augmented the risk of dialysis dependence in the subgroups of patients treated with non-CRRT modality and whose Sequential Organ Failure Assessment (SOFA) score were more than 11. Conclusions In this meta-analysis, critically ill patients with severe AKI would benefit from accelerated RRT initiation regarding all-cause mortality and being eventually free of dialysis only if they were surgical ICU patients or if they underwent CRRT treatment. However, the risk of dialysis dependence was increased in the accelerated RRT group when those patients used non-CRRT modality or had high SOFA scores. All the literatures reviewed in this study were highly heterogeneous and potentially subject to biases. Trial registration CRD42020201466, Sep 07, 2020. https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=201466.

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Intermittent Convective Therapies in Patients with Acute Kidney Injury: A Systematic Review with Meta-Analysis

Blood Purification ◽

10.1159/000515641 ◽

2021 ◽

pp. 1-12

Author(s):

Jean Maxime Côté ◽

Louis Pinard ◽

Jean-Francois Cailhier ◽

Renée Lévesque ◽

Patrick T. Murray ◽

...

Keyword(s):

Systematic Review ◽

Acute Kidney Injury ◽

Observational Studies ◽

Meta Analysis ◽

Kidney Injury ◽

Renal Recovery ◽

Cochrane Library ◽

Significant Difference ◽

Short Term Mortality ◽

Circuit Loss

Introduction: In critically ill patients requiring intermittent renal replacement therapy (RRT), the benefits of convective versus diffusive clearance remain uncertain. We conducted a systematic review and meta-analysis to determine the safety, clinical efficacy, and clearance efficiency of hemofiltration (HF) and hemodiafiltration (HDF) compared to hemodialysis (HD) in patients with acute kidney injury (AKI) receiving intermittent RRT. Method: We searched Medline, Embase, Cochrane Library, and PROSPERO. We included clinical trials and observational studies that reported the use of intermittent HF or HDF in adult patients with AKI. The following outcomes were included: mortality, renal recovery, clearance efficacy, intradialytic hemodynamic stability, circuit loss, and inflammation modulation. Results: A total of 3,169 studies were retrieved and screened. Four randomized controlled trials and 4 observational studies were included (n: 615 patients). Compared with conventional HD, intermittent convective therapies had no effect on in-hospital mortality (relative risk, 1.23; 95% confidence interval (CI), 0.76–1.99), renal recovery at 30 days (RR, 0.98; 95% CI, 0.82–1.16), time-to-renal recovery (mean difference [MD], 0.77; 95% CI, −6.56 to 8.10), and number of dialysis sessions until renal recovery (MD, −1.34; 95% CI, −3.39 to 0.72). The overall quality of included studies was low, and dialysis parameters were suboptimal for all included studies. Conclusion: This meta-analysis suggests that there is no significant difference in short-term mortality and renal recovery in patients with severe AKI when treated with intermittent HF or HDF compared to conventional HD. This systematic review emphasizes the need for further trials evaluating optimal convective parameters in AKI patients treated with intermittent dialysis.

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Efficacy and safety of thromboprophylaxis in cancer patients: a systematic review and meta-analysis

Therapeutic Advances in Medical Oncology ◽

10.1177/1758835920907540 ◽

2020 ◽

Vol 12 ◽

pp. 175883592090754

Author(s):

Miao Liu ◽

Guiyue Wang ◽

Yuhang Li ◽

Hongliang Wang ◽

Haitao Liu ◽

...

Keyword(s):

Systematic Review ◽

Major Bleeding ◽

Meta Analysis ◽

Cochrane Library ◽

Efficacy And Safety ◽

Bleeding Events ◽

Patients With Cancer ◽

Significant Difference ◽

All Cause Mortality ◽

The Cochrane Library

Background: Thrombosis is a common complication in patients with cancer. Whether thromboprophylaxis could benefit patients with cancer is unclear. The aim of this systematic review was to determine the efficacy and safety of thromboprophylaxis in patients with cancer undergoing surgery or chemotherapy. Methods: We searched the Cochrane Library, EMBASE, MEDLINE, EBSCOhost, and Web of Science for studies published before May 2018 to investigate whether thromboprophylaxis measures were more effective than a placebo in patients with cancer. Results: In total, 33 trials with 11,942 patients with cancer were identified. In patients with cancer undergoing surgery, the administration of thromboprophylaxis was associated with decreasing trends in venous thromboembolism (VTE) [relative risk (RR) 0.51, 95% confidence interval (CI) 0.32–0.81] and DVT (RR 0.53, 95% CI 0.33–0.87). In patients with cancer undergoing chemotherapy, the administration of thromboprophylaxis reduced the incidences of VTE, DVT, and pulmonary embolism compared with no thromboprophylaxis (RR 0.54, 95% CI 0.40–0.73; RR 0.47, 95% CI 0.31–0.73; RR 0.51, 95% CI 0.32–0.81, respectively). The pooled results regarding major bleeding showed no significant difference between prophylaxis and no prophylaxis in either the surgical or the chemotherapy groups (RR 2.35, 95% CI 0.74–7.52, p = 0.1482, I2 = 0%; RR 1.30, 95% CI 0.93–1.83, p = 0.1274, I2 = 0%, respectively). Conclusion: Thromboprophylaxis did not increase major bleeding events or the incidence of thrombocytopenia. All-cause mortality was not significantly different between those who received thromboprophylaxis and those who did not. This meta-analysis provides evidence that thromboprophylaxis can reduce the number of VTE and DVT events, with no apparent increase in the incidence of major bleeding in patients with cancer.

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