Open AccessUltrafiltration and cardiopulmonary bypass associated acute kidney injury: A systematic review and meta‐analysis
Author(s) -
Kandil Omneya A.,
Motawea Karam R.,
Darling Edward,
Riley Jeffrey B.,
Shah Jaffer,
Elashhat Mohamed Abdalla Mohamed,
Searles Bruce,
Aiash Hani
Publication year - 2021
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.23750
Subject(s) - medicine , acute kidney injury , cardiopulmonary bypass , ultrafiltration (renal) , subgroup analysis , meta analysis , relative risk , perioperative , incidence (geometry) , renal function , confidence interval , surgery , chemistry , physics , chromatography , optics
Abstract Background Cardiopulmonary bypass is known to raise the risk of acute kidney injury (AKI). Previous studies have identified numerous risk factors of cardiopulmonary bypass including the possible impact of perioperative ultrafiltration. However, the association between ultrafiltration (UF) and AKI remains conflicting. Thus, we conducted a meta‐analysis to further examine the relationship between UF and AKI. Hypothesis Ultrafiltration during cardiac surgery increases the risk of developping Acute kidney Injury. Methods We searched PubMed, Web of Science, EBSCO, and SCOPUS through July 2021. The RevMan (version 5.4) software was used to calculate the pooled risk ratios (RRs) and mean differences along with their associated confidence intervals (95% CI). Results We identified 12 studies with a total of 8005 patients. There was no statistically significant difference in the incidence of AKI between the group who underwent UF and the control group who did not (RR = 0.90, 95% CI = 0.64−1). Subgroup analysis on patients with previous renal insufficiency also yielded nonsignificant difference (RR = 0.84, 95% CI = 0.53 −1.33, p = .47). Subgroup analysis based on volume of ultrafiltrate removed (> or <2900 ml) was not significant and did not increase the AKI risk as predicted (RR = 0.82, 95% CI = 0.63 −1.07, p = .15). We also did subgroup analysis according to the type of UF and again no significant difference in AKI incidence between UF groups and controls was observed in either the conventional ultrafiltration (CUF), modified ultrafiltration (MUF), zero‐balanced ultrafiltration (ZBUF), or combined MUF and CUF subgroups. Conclusion UF in cardiac surgery is not associated with increased AKI incidence and may be safely used even in baseline chronic injury patients.