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Am J Nephrol. 2010;31(5):408-18. doi: 10.1159/000296277. Epub 2010 Apr 6.

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

Author information

1
Clinical Epidemiology Research Center, Veterans Affairs Medical Center, West Haven, Conn. 06516, USA.

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.

PMID:
20375494
PMCID:
PMC2883845
DOI:
10.1159/000296277
[Indexed for MEDLINE]
Free PMC Article

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