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Pharmacological interventions for the prevention of renal injury in surgical patients: a systematic literature review and meta-analysis
BACKGROUND: 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. METHODS: Searches were conducted to update a previous review using the Cochrane Central...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7844346/ https://www.ncbi.nlm.nih.gov/pubmed/32828488 http://dx.doi.org/10.1016/j.bja.2020.06.064 |
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author | Pathak, Suraj Olivieri, Guido Mohamed, Walid Abbasciano, Riccardo Roman, Marius Tomassini, Sara Lai, Florence Wozniak, Marcin Murphy, Gavin J. |
author_facet | Pathak, Suraj Olivieri, Guido Mohamed, Walid Abbasciano, Riccardo Roman, Marius Tomassini, Sara Lai, Florence Wozniak, Marcin Murphy, Gavin J. |
author_sort | Pathak, Suraj |
collection | PubMed |
description | BACKGROUND: 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. METHODS: 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). RESULTS: 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. CONCLUSIONS: There are multiple effective pharmacological renoprotective interventions for people undergoing surgery. |
format | Online Article Text |
id | pubmed-7844346 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
spelling | pubmed-78443462021-02-05 Pharmacological interventions for the prevention of renal injury in surgical patients: a systematic literature review and meta-analysis Pathak, Suraj Olivieri, Guido Mohamed, Walid Abbasciano, Riccardo Roman, Marius Tomassini, Sara Lai, Florence Wozniak, Marcin Murphy, Gavin J. Br J Anaesth Review Article BACKGROUND: 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. METHODS: 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). RESULTS: 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. CONCLUSIONS: There are multiple effective pharmacological renoprotective interventions for people undergoing surgery. Elsevier 2021-01 2020-08-20 /pmc/articles/PMC7844346/ /pubmed/32828488 http://dx.doi.org/10.1016/j.bja.2020.06.064 Text en © 2020 The Authors http://creativecommons.org/licenses/by/4.0/ This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Review Article Pathak, Suraj Olivieri, Guido Mohamed, Walid Abbasciano, Riccardo Roman, Marius Tomassini, Sara Lai, Florence Wozniak, Marcin Murphy, Gavin J. Pharmacological interventions for the prevention of renal injury in surgical patients: a systematic literature review and meta-analysis |
title | Pharmacological interventions for the prevention of renal injury in surgical patients: a systematic literature review and meta-analysis |
title_full | Pharmacological interventions for the prevention of renal injury in surgical patients: a systematic literature review and meta-analysis |
title_fullStr | Pharmacological interventions for the prevention of renal injury in surgical patients: a systematic literature review and meta-analysis |
title_full_unstemmed | Pharmacological interventions for the prevention of renal injury in surgical patients: a systematic literature review and meta-analysis |
title_short | Pharmacological interventions for the prevention of renal injury in surgical patients: a systematic literature review and meta-analysis |
title_sort | pharmacological interventions for the prevention of renal injury in surgical patients: a systematic literature review and meta-analysis |
topic | Review Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7844346/ https://www.ncbi.nlm.nih.gov/pubmed/32828488 http://dx.doi.org/10.1016/j.bja.2020.06.064 |
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