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- Title
Comparative Efficacy of Drugs for Preventing Acute Kidney Injury after Cardiac Surgery: A Network Meta-Analysis.
- Authors
Chen, Xi; Huang, Tianlun; Cao, Xuan; Xu, Gaosi
- Abstract
Background: Acute kidney injury (AKI) occurs frequently after cardiac surgery and has been associated with increased hospital length of stay, mortality, and costs. Objective: We aimed to evaluate the efficacy of pharmacologic strategies for preventing AKI after cardiac surgery. Methods: We searched PubMed, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL) up to 6 May 2017 and the reference lists of relevant articles about trials. The outcome was the occurrence of AKI. This is the first network meta-analysis of the different prevention strategies using Bayesian methodology. Results: The study included 63 articles with 19,520 participants and evaluated the effect of ten pharmacologic strategies to prevent AKI in patients undergoing cardiac surgery. Compared with placebo, the odds ratio (OR) for the occurrence of AKI was 0.24 [95% confidence interval (CI) 0.16-0.34] with natriuretic peptide, 0.33 (95% CI 0.14-0.70) with fenoldopam, 0.54 (95% CI 0.31-0.84) with dexmedetomidine, 0.56 (95% CI 0.29-0.95) with low-dose erythropoietin, 0.63 (95% CI 0.43-0.88) with levosimendan, 0.76 (95% CI 0.52-1.10) with steroids, 0.83 (95% CI 0.48-1.40) with high-dose erythropoietin, 0.85 (95% CI 0.64-1.14) with N-acetylcysteine, 0.96 (95% CI 0.69-1.29) with sodium bicarbonate, and 1.05 (95% CI 0.70-1.41) with statins. The surface under the cumulative ranking curve probabilities indicated that natriuretic peptide was the best treatment therapy and that fenoldopam ranked second. Conclusions: Natriuretic peptide is probably the preferred pharmacologic strategy to prevent AKI in adult patients undergoing cardiac surgery, especially in those at high risk of AKI.
- Subjects
ACUTE kidney failure prevention; STEROID drugs; SODIUM bicarbonate; STATINS (Cardiovascular agents); IMIDAZOLES; FENOLDOPAM (Drug); ACETYLCYSTEINE; NATRIURETIC peptides; CONFIDENCE intervals; ACUTE kidney failure; ERYTHROPOIETIN; CARDIAC surgery; INFORMATION storage &; retrieval systems; MEDICAL databases; MEDICAL information storage &; retrieval systems; MEDLINE; META-analysis; ONLINE information services; PROBABILITY theory; SURGICAL complications; SYSTEMATIC reviews; TREATMENT effectiveness; ODDS ratio; THERAPEUTICS; DISEASE risk factors
- Publication
American Journal of Cardiovascular Drugs, 2018, Vol 18, Issue 1, p49
- ISSN
1175-3277
- Publication type
Article
- DOI
10.1007/s40256-017-0245-0