Prevention and treatment of acute kidney injury in patients undergoing cardiac surgery: A systematic review

Meyeon Park, Steven G. Coca, Sagar U. Nigwekar, Amit X. Garg, Susan Garwood, Chirag R. Parikh

Research output: Contribution to journalReview article

Abstract

Background: Acute kidney injury (AKI) is common in patients undergoing cardiac surgery and is associated with a high rate of death, long-term sequelae and healthcare costs. We conducted a systematic review of randomized controlled trials for strategies to prevent or treat AKI in cardiac surgery. Methods: We screened Medline, Scopus, Cochrane Renal Library, and Google Scholar for randomized controlled trails in cardiac surgery for prevention or treatment of AKI in adults. Results: We identified 70 studies that contained a total of 5,554 participants published until November 2008. Most studies were small in sample size, were single-center, focused on preventive strategies, and displayed wide variation in AKI definitions. Only 26% were assessed to be of high quality according to the Jadad criteria. The types of strategies with possible protective efficacy were dopaminergic agents, vasodilators, anti-inflammatory agents, and pump/perfusion strategies. When analyzed separately, dopamine and N-acetylcysteine did not reduce the risk for AKI. Conclusions: This summary of all the literature on prevention and treatment strategies for AKI in cardiac surgery highlights the need for better information. The results advocate large, good-quality, multicenter studies to determine whether promising interventions reliably reduce rates of acute renal replacement therapy and mortality in the cardiac surgery setting.

Original languageEnglish (US)
Pages (from-to)408-418
Number of pages11
JournalAmerican Journal of Nephrology
Volume31
Issue number5
DOIs
StatePublished - May 1 2010

Keywords

  • Acute kidney injury
  • Cardiac surgery
  • Healthcare costs
  • Prevention

ASJC Scopus subject areas

  • Nephrology

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