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Anti‐Inflammatory Strategies to Reduce Acute Kidney Injury in Cardiac Surgery Patients: A Meta‐Analysis of Randomized Controlled Trials
Author(s) -
Scrascia Giuseppe,
Guida Pietro,
Rotunno Crescenzia,
Luca Tupputi Schinosa Luigi,
Paparella Domenico
Publication year - 2014
Publication title -
artificial organs
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.684
H-Index - 76
eISSN - 1525-1594
pISSN - 0160-564X
DOI - 10.1111/aor.12127
Subject(s) - medicine , acute kidney injury , randomized controlled trial , placebo , extracorporeal circulation , cardiopulmonary bypass , incidence (geometry) , dialysis , renal function , pathology , optics , physics , alternative medicine
Acute kidney injury ( AKI ) after cardiac operations is a serious complication associated with postoperative mortality. Multiple factors contribute to AKI development, principally ischemia‐reperfusion injury and inflammatory response. It is well proven that glucocorticoid administration, leukocyte filter application, and miniaturized extracorporeal circuits ( MECC ) modulate inflammatory response. We conducted a systematic review of randomized controlled trials ( RCTs ) in which one of these inflammatory system modulation strategies was used, with the aim to evaluate the effects on postoperative AKI . MEDLINE and C ochrane L ibrary were screened through N ovember 2011 for RCTs in which an inflammatory system modulation strategy was adopted. Included were trials that reported data about postoperative renal outcomes. Because AKI was defined by different criteria, including biochemical determinations, urine output, or dialysis requirement, we unified renal outcome as worsening renal function ( WRF ). We identified 14 trials for steroids administration (931 patients, WRF incidence [treatment vs. placebo]: 2.7% vs. 2.4%; OR : 1.13; 95% CI : 0.53–2.43; P = 0.79), 9 trials for MECC (947 patients, WRF incidence: 2.4% vs. 0.9%; OR : 0.47; 95% CI : 0.18–1.25; P = 0.13), 6 trials for leukocyte filters (374 patients, WRF incidence: 1.1% vs. 7.5%; OR : 0.18; 95% CI : 0.05–0.64; P = 0.008). Only leukocyte filters effectively reduced WRF incidence. Not all cardiopulmonary bypass‐related anti‐inflammatory strategies analyzed reduced renal damage after cardiac operations. In adult patients, probably other factors are predominant on inflammation in determining AKI , and only leukocyte filters were effective. Large multicenter RCTs are needed in order to better evaluate the role of inflammation in AKI development after cardiac operations.