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Li B, Lang X, Cao L, Wang Y, Lu Y, Feng S, Yang Y, Chen J, Jiang H. Effect of remote ischemic preconditioning on postoperative acute kidney injury among patients undergoing cardiac and vascular interventions: a meta-analysis. J Nephrol 2016; 30:19-33. [PMID: 27091767 PMCID: PMC5316401 DOI: 10.1007/s40620-016-0301-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Accepted: 03/25/2016] [Indexed: 12/17/2022]
Abstract
It is currently controversial whether remote ischemic preconditioning (RIPC) reduces the incidence of acute kidney injury (AKI) in patients undergoing cardiovascular interventions. The main objective of this meta-analysis was to investigate whether RIPC provides renal protection for patients undergoing cardiac or vascular surgery. We searched the PubMed database (1966-Oct 2015), Embase database (1966-Oct 2015), Google Scholar, Cochrane Library, ClinicalTrials Database and Open Grey. Then we conducted a meta-analysis of the randomized controlled trials that met the inclusion criteria of our study. The interventions included use of an inflatable tourniquet around the limbs or cross-clamping of the iliac arteries before surgery (RIPC groups) and general cardiovascular intervention (control groups). The main outcomes examined included the incidence of AKI; changes in acute kidney injury biomarkers; and use of renal replacement therapy. Other outcomes examined included in-hospital mortality and the lengths of hospital stay and intensive care unit (ICU) stay. Finally, we screened 26 eligible studies containing 6699 patients who underwent cardiac or vascular interventions with RIPC (n = 3343) or without RIPC (n = 3356). The AKI incidence was decreased in the RIPC group as was the length of ICU stay. There were no differences in the changes in AKI biomarkers, use of renal replacement therapy or in-hospital mortality between the two groups. Remote ischemic preconditioning may decrease the occurrence of AKI in cardiovascular surgery patients. Since studies included have a significant heterogeneity, meta-analyses using a stricter inclusion criteria are needed to clarify the renoprotection effect of RIPC.
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Affiliation(s)
- Bingjue Li
- Kidney Disease Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, Qinchun Road 79#, Hangzhou, 310003, People's Republic of China.,Kidney Disease Immunology Laboratory, The Third Grade Laboratory, State Administration of Traditional Chinese Medicine of P.R. China, Hangzhou, People's Republic of China.,Key Laboratory of Multiple Organ Transplantation, Ministry of Health, Hangzhou, People's Republic of China.,Key Laboratory of Nephropathy, Zhejiang Province, Hangzhou, Zhejiang, People's Republic of China
| | - Xiabing Lang
- Kidney Disease Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, Qinchun Road 79#, Hangzhou, 310003, People's Republic of China.,Kidney Disease Immunology Laboratory, The Third Grade Laboratory, State Administration of Traditional Chinese Medicine of P.R. China, Hangzhou, People's Republic of China.,Key Laboratory of Multiple Organ Transplantation, Ministry of Health, Hangzhou, People's Republic of China.,Key Laboratory of Nephropathy, Zhejiang Province, Hangzhou, Zhejiang, People's Republic of China
| | - Luxi Cao
- Kidney Disease Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, Qinchun Road 79#, Hangzhou, 310003, People's Republic of China.,Kidney Disease Immunology Laboratory, The Third Grade Laboratory, State Administration of Traditional Chinese Medicine of P.R. China, Hangzhou, People's Republic of China.,Key Laboratory of Multiple Organ Transplantation, Ministry of Health, Hangzhou, People's Republic of China.,Key Laboratory of Nephropathy, Zhejiang Province, Hangzhou, Zhejiang, People's Republic of China
| | - Yuchen Wang
- Kidney Disease Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, Qinchun Road 79#, Hangzhou, 310003, People's Republic of China.,Kidney Disease Immunology Laboratory, The Third Grade Laboratory, State Administration of Traditional Chinese Medicine of P.R. China, Hangzhou, People's Republic of China.,Key Laboratory of Multiple Organ Transplantation, Ministry of Health, Hangzhou, People's Republic of China.,Key Laboratory of Nephropathy, Zhejiang Province, Hangzhou, Zhejiang, People's Republic of China
| | - Yingying Lu
- Kidney Disease Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, Qinchun Road 79#, Hangzhou, 310003, People's Republic of China.,Kidney Disease Immunology Laboratory, The Third Grade Laboratory, State Administration of Traditional Chinese Medicine of P.R. China, Hangzhou, People's Republic of China.,Key Laboratory of Multiple Organ Transplantation, Ministry of Health, Hangzhou, People's Republic of China.,Key Laboratory of Nephropathy, Zhejiang Province, Hangzhou, Zhejiang, People's Republic of China
| | - Shi Feng
- Kidney Disease Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, Qinchun Road 79#, Hangzhou, 310003, People's Republic of China.,Kidney Disease Immunology Laboratory, The Third Grade Laboratory, State Administration of Traditional Chinese Medicine of P.R. China, Hangzhou, People's Republic of China.,Key Laboratory of Multiple Organ Transplantation, Ministry of Health, Hangzhou, People's Republic of China.,Key Laboratory of Nephropathy, Zhejiang Province, Hangzhou, Zhejiang, People's Republic of China
| | - Yi Yang
- Kidney Disease Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, Qinchun Road 79#, Hangzhou, 310003, People's Republic of China.,Kidney Disease Immunology Laboratory, The Third Grade Laboratory, State Administration of Traditional Chinese Medicine of P.R. China, Hangzhou, People's Republic of China.,Key Laboratory of Multiple Organ Transplantation, Ministry of Health, Hangzhou, People's Republic of China.,Key Laboratory of Nephropathy, Zhejiang Province, Hangzhou, Zhejiang, People's Republic of China
| | - Jianghua Chen
- Kidney Disease Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, Qinchun Road 79#, Hangzhou, 310003, People's Republic of China.,Kidney Disease Immunology Laboratory, The Third Grade Laboratory, State Administration of Traditional Chinese Medicine of P.R. China, Hangzhou, People's Republic of China.,Key Laboratory of Multiple Organ Transplantation, Ministry of Health, Hangzhou, People's Republic of China.,Key Laboratory of Nephropathy, Zhejiang Province, Hangzhou, Zhejiang, People's Republic of China
| | - Hong Jiang
- Kidney Disease Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, Qinchun Road 79#, Hangzhou, 310003, People's Republic of China. .,Kidney Disease Immunology Laboratory, The Third Grade Laboratory, State Administration of Traditional Chinese Medicine of P.R. China, Hangzhou, People's Republic of China. .,Key Laboratory of Multiple Organ Transplantation, Ministry of Health, Hangzhou, People's Republic of China. .,Key Laboratory of Nephropathy, Zhejiang Province, Hangzhou, Zhejiang, People's Republic of China.
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Nam MJ, Lim CH, Kim HJ, Kim YH, Choi H, Son HS, Lim HJ, Sun K. A Meta-Analysis of Renal Function After Adult Cardiac Surgery With Pulsatile Perfusion. Artif Organs 2015; 39:788-94. [PMID: 25865900 DOI: 10.1111/aor.12452] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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.
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Affiliation(s)
- Myung Ji Nam
- School of Medicine, Korea University, Seoul, Korea
| | - Choon Hak Lim
- Anesthesiology and Pain Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Hyun-Jung Kim
- Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Yong Hwi Kim
- Anesthesiology and Pain Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Hyuk Choi
- Department of Medical Science, Graduate School of Medicine, Korea University, Seoul, Korea
| | - Ho Sung Son
- Thoracic and Cardiovascular Surgery, Korea University, Seoul, Korea
| | - Hae Ja Lim
- Anesthesiology and Pain Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Kyung Sun
- Thoracic and Cardiovascular Surgery, Korea University, Seoul, Korea
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