Pharmacological interventions for the prevention of acute kidney injury after pediatric cardiac surgery: a network meta-analysis
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Acute kidney injury constitutes a major complication of cardiac surgery in pediatric patients. The present meta-analysis aims to accumulate current literature and assess the efficacy of pharmacological interventions in preventing postoperative renal dysfunction after congenital heart surgery.
Literature search was conducted using Medline (1966–2018), Scopus (2004–2018), Cochrane Central Register of Controlled Trials CENTRAL (1999–2018), Clinicaltrials.gov (2008–2018), and Google Scholar (2004–2018) databases. Statistical analysis was performed with Review Manager 5.3 and R 3.4.3.
Meta-analysis included 14 studies, with a total of 2,625 patients. AKI incidence was significantly lower in the dexmedetomidine (OR 0.49, 95% CI [0.28–0.87]) and acetaminophen (OR 0.43, 94% CI [0.28–0.67]) groups, while no difference was present in patients receiving corticosteroid (OR 1.16, 95% CI [0.69–1.95]), fenoldopam (OR 0.47, 95% CI [0.22–1.02]), or aminophylline (OR 0.98, 95% CI [0.29–3.34]). Network meta-analysis proposed that dexmedetomidine had the greatest probability (44.5%) to rank first, although significant overlap with the other treatments was observed.
The present meta-analysis suggests that no firm evidence exists about the protective role of pharmacological interventions in the pediatric population. Future randomized controlled trials should clarify the effectiveness of dexmedetomidine and acetaminophen and indicate the optimal protocol to be applied, to protect renal function in the perioperative setting.
KeywordsAcute kidney injury Pediatric Cardiac surgery Prevention
Compliance with ethical standards
Conflict of interest
The authors have declared that no conflict of interest exists.
The present systematic review and meta-analysis is based on aggregated data that were retrieved from studies already retrieved. We did not collect individual patient data and did not have direct contact with patients included.
- 10.Kramer RS, Herron CR, Groom RC, Brown JR. Acute kidney injury subsequent to cardiac surgery. J Extra Corpor Technol. 2015;47:16–28.Google Scholar
- 16.Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract. Karger Publ. 2012;120:c179–84.Google Scholar
- 21.Plummer M. JAGS Software, version 4.0.0. 2015. http://mcmc-jags.sourceforge.net/. Accessed 5 Aug 2018.
- 32.Axelrod DM, Sutherland SM, Anglemyer A, Grimm PC, Roth SJ, Double-Blinded A. Randomized, placebo-controlled clinical trial of aminophylline to prevent acute kidney injury in children following congenital heart surgery with cardiopulmonary bypass. Pediatr Crit Care Med. 2016;17:135–43.CrossRefGoogle Scholar