title: Pharmacological strategies for the prevention of acute kidney injury following cardiac surgery: an overview of systematic reviews.
abstract: BACKGROUND
  Post cardiac surgery acute kidney injury (AKI) is common, poorly understood and associated with a significant increase in morbidity and mortality.
  
  
  OBJECTIVE
  An overview of systematic reviews that have evaluated pharmacological agents for the prevention of AKI post cardiac surgery.
  
  
  METHODS
  We searched electronic databases (PubMed and the Cochrane Database of Systematic Reviews) from inception to January 2014.
  
  
  METHODS
  Systematic reviews of randomized controlled trials that have evaluated pharmacological agents for the prevention of AKI in adult patients undergoing cardiac surgery.
  
  
  METHODS
  Numbers needed to treat (NNT) or harm (NNH) were calculated from pooled events given in each meta-analysis. Primary outcome measures were defined as (i) mortality, (ii) need for renal replacement therapy (RRT), and (iii) acute kidney injury.
  
  
  RESULTS
  Data from 7 systematic reviews evaluating 6 different pharmacological renoprotective agents were included. Dopamine, fenoldopam and N-acetylcysteine did not demonstrate any benefit in terms of mortality, need for RRT or incidence of AKI. Atrial natriuretic peptide reduced the need for RRT (NNT = 22 (95% CI: 13 to 73) and brain natriuretic peptide reduced the incidence of AKI (NNT = 11 (95% CI: 6 to 32), although both agents did not demonstrate any effect on mortality. Loop diuretics demonstrated increased incidence of AKI (NNH = 8 (95% CI: 5 to 15).
  
  
  CONCLUSIONS
  There is a paucity of effective renoprotective agents that can be used in adult cardiac surgical patients. There is an urgent need to develop novel renoprotective strategies.
authors.forename: Nishith N
authors.initials: NN
authors.lastname: Patel
authors.affiliation: Angelini, Level 7, Queen's Building, Bristol Heart Institute, Bristol Royal Infirmary, Marlborough Street, Bristol. United Kingdom. BS2 8HW. g.d.angelini@bristol.ac.uk.
authors.forename: Gianni D
authors.initials: GD
authors.lastname: Angelini
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D000818:Animals; D009320:Atrial Natriuretic Factor / Q000008:administration & dosage; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D006801:Humans; D020097:Natriuretic Peptide, Brain / Q000008:administration & dosage; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D012196:Review Literature as Topic
chemical_list: D020097:Natriuretic Peptide, Brain; D009320:Atrial Natriuretic Factor