title: A Meta-Analysis of Renal Function After Adult Cardiac Surgery With Pulsatile Perfusion.
abstract: The aim of this meta-analysis was to determine whether pulsatile perfusion during cardiac surgery has a lesser effect on renal dysfunction than nonpulsatile perfusion after cardiac surgery in randomized controlled trials. MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were used to identify available articles published before April 25, 2014. Meta-analysis was conducted to determine the effects of pulsatile perfusion on postoperative renal functions, as determined by creatinine clearance (CrCl), serum creatinine (Cr), urinary neutrophil gelatinase-associated lipocalin (NGAL), and the incidences of acute renal insufficiency (ARI) and acute renal failure (ARF). Nine studies involving 674 patients that received pulsatile perfusion and 698 patients that received nonpulsatile perfusion during cardiopulmonary bypass (CPB) were considered in the meta-analysis. Stratified analysis was performed according to effective pulsatility or unclear pulsatility of the pulsatile perfusion method in the presence of heterogeneity. NGAL levels were not significantly different between the pulsatile and nonpulsatile groups. However, patients in the pulsatile group had a significantly higher CrCl and lower Cr levels when the analysis was restricted to studies on effective pulsatile flow (P < 0.00001, respectively). The incidence of ARI was significantly lower in the pulsatile group (P < 0.00001), but incidences of ARF were similar. In conclusion, the meta-analysis suggests that the use of pulsatile flow during CPB results in better postoperative renal function.
authors: School of Medicine, Korea University, Seoul, Korea.
authors: Myung Ji
authors: MJ
authors: Nam
authors: Anesthesiology and Pain Medicine, College of Medicine, Korea University, Seoul, Korea.
authors: Choon Hak
authors: CH
authors: Lim
authors: Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Korea.
authors: Hyun-Jung
authors: HJ
authors: Kim
authors: Anesthesiology and Pain Medicine, College of Medicine, Korea University, Seoul, Korea.
authors: Yong Hwi
authors: YH
authors: Kim
authors: Department of Medical Science, Graduate School of Medicine, Korea University, Seoul, Korea.
authors: Hyuk
authors: H
authors: Choi
authors: Thoracic and Cardiovascular Surgery, Korea University, Seoul, Korea.
authors: Ho Sung
authors: HS
authors: Son
authors: Anesthesiology and Pain Medicine, College of Medicine, Korea University, Seoul, Korea.
authors: Hae Ja
authors: HJ
authors: Lim
authors: Thoracic and Cardiovascular Surgery, Korea University, Seoul, Korea.
authors: Kyung
authors: K
authors: Sun
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood* / Q000209:etiology* / Q000503:physiopathology / Q000652:urine; D000209:Acute-Phase Proteins / Q000652:urine; D000328:Adult; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000295:instrumentation; D002315:Cardiopulmonary Bypass / Q000009:adverse effects* / Q000295:instrumentation; D003404:Creatinine / Q000097:blood; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D007677:Kidney Function Tests; D000071068:Lipocalin-2; D054834:Lipocalins / Q000652:urine; D010477:Perfusion / Q000009:adverse effects / Q000295:instrumentation; D011183:Postoperative Complications / Q000097:blood / Q000209:etiology / Q000503:physiopathology / Q000652:urine; D011518:Proto-Oncogene Proteins / Q000652:urine; D011673:Pulsatile Flow
chemical_list: D000209:Acute-Phase Proteins; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins; D003404:Creatinine
keywords: Cardiopulmonary bypass; Meta-analysis; Pulsatile perfusion; Renal function