A Meta-Analysis of Renal Function After Adult Cardiac Surgery With Pulsatile Perfusion

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.

Cardiac and Vascular Surgery–Associated Acute Kidney Injury: The 20th International Consensus Conference of the ADQI (Acute Disease Quality Initiative) Group

“…Pulsatile perfusion provides surplus mechanical energy transmission to the vascular endothelium. Its impact on clinical outcomes has been extensively studied in a variety of settings; however, the data on renal outcomes are conflicting because of the lack of uniformity in pulsatility delivery . A retrospective analysis showed pulsatile CPB conferred a renoprotective effect in higher risk patients undergoing cardiac surgery .…”

“…Its impact on clinical outcomes has been extensively studied in a variety of settings; however, the data on renal outcomes are conflicting because of the lack of uniformity in pulsatility delivery. 159,[183][184][185] A retrospective analysis showed pulsatile CPB conferred a renoprotective effect in higher risk patients undergoing cardiac surgery. 186 However, the contemporary use of implantable continuous-flow left ventricular assist devices challenges this concept.…”

Pharmacokinetics and Safety of Micafungin in Infants Supported With Extracorporeal Membrane Oxygenation

“…Non-pulsatile blood flow may be associated with reduced renal function, but its impact on a drug cleared by transporters in the liver such as micafungin is unknown. 39 …”

Acute and chronic effects of continuous‐flow support and pulsatile‐flow support

“…These authors concluded that CF had greater effect on postoperative pulmonary dysfunction, including acute respiratory insufficiency, compared to PF. Nam et al also demonstrated that PF had positive effects on renal function as shown by greater creatinine clearance and a lower incidence of acute kidney injury, especially in high‐risk patients. However, it is not fully understood to what extent these clinical effects are influenced by NO upregulation during PF support.…”