Cardiothoracic & vascular anesthesia
Prevention of cardiac surgery-associated acute kidney injury: a systematic review and meta-analysis of non-pharmacological interventions
Authors' conclusion
Two non-pharmacological interventions are likely to reduce CSA-AKI incidence, with moderate quality of evidence: goal-directed perfusion and remote ischemic preconditioning.
Study context
- Population
- Adults undergoing cardiac surgery (randomized controlled trials (RCTs) of heart transplantation or pediatric populations excluded)
- Participants
- 25,855 adults · 86 trials
- Comparison
- Non-pharmacological interventions vs control for prevention of cardiac surgery-associated acute kidney injury (CSA-AKI)
- Outcome
- Cardiac surgery-associated AKI (CSA-AKI)
Methodological detailsrandom-effects, GRADE quality of evidence, Searched PubMed, Embase, Central and trial registries, January 1, 2004 to July 1, 2023, no language restriction
- Random-effects
- GRADE quality of evidence
- Searched PubMed, Embase, Central and trial registries, January 1, 2004 to July 1, 2023, no language restriction
Pooled result
As reported in the abstract
CSA-AKI incidence
Relative risk (95% CI)
Goal-directed perfusionI2 = 0%; Phet = 0.44; moderate quality of evidence
0.55(0.40–0.76)
Remote ischemic preconditioningI2 = 23%; Phet = 0.07; moderate quality of evidence
0.86(0.78–0.95)
Pulsatile flowI2 = 53%; Phet < 0.01; very low quality of evidence
0.69(0.48–0.99)
Restrictive transfusion strategyPhet = 0.67; I2 = 3%; high quality of evidence for lack of effect
1.02(0.92–1.12)
Tight glycemic controlPhet = 0.25; I2 = 26%; high quality of evidence for lack of effect
0.86(0.55–1.35)
Original publication
Prevention of cardiac surgery-associated acute kidney injury: a systematic review and meta-analysis of non-pharmacological interventions. Crit Care. Published 12 September 2023. doi:10.
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