Prevention and treatment of acute kidney injury in patients undergoing cardiac surgery: a systematic review.
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.
Park
Meyeon
M
Clinical Epidemiology Research Center, Veterans Affairs Medical Center, West Haven, Conn. 06516, USA.
Coca
Steven G
SG
Nigwekar
Sagar U
SU
Garg
Amit X
AX
Garwood
Susan
S
Parikh
Chirag R
CR
D058186:Acute Kidney Injury / Q000517:prevention & control* / Q000628:therapy*; D000368:Aged; D015259:Dopamine Agents / Q000627:therapeutic use; D005260:Female; D006331:Heart Diseases / Q000150:complications / Q000601:surgery; D006801:Humans; D007249:Inflammation; D007668:Kidney / Q000293:injuries; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D017582:Renal Replacement Therapy / Q000379:methods; D012307:Risk Factors; D013903:Thoracic Surgery; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000627:therapeutic use
D015259:Dopamine Agents; D014665:Vasodilator Agents