Effect of Vasopressin and its Analogs versus Catecholamines on the Renal Outcomes in Septic Shock:A Systematic Review and Meta-Analysis of Randomized Trials

Abstract

Background: This current systematic review and meta-analysis aimed to evaluate the association of Vasopressin and its analogs and adverse renal outcomes compared to Catecholamines in adult patients with septic shock. Method: We performed a systematic review of the literature published from inception to March 31, 2021, using online databases of PubMed, Embase, Cochrane Library. Randomized controlled trials reporting any renal function and comparing Vasopressin and its analogs with Catecholamines among adult septic shock patients. Our primary outcomes relating to acute renal failure were acute kidney injury incidence and the need for Renal replacement therapy. Our secondary outcomes were three: Renal replacement therapy free-days and 48h post-administration change in creatinine level and urine output. We applied a fixed-effects model to estimate the risk ratio (RR) for (dichotomized outcomes) and standard mean difference (SMD) for (continues outcomes). Results: 18 trials met the inclusion criteria with a total of 4,024 patients. 13 studies were eligible for quantitative meta-analysis and 5 studies were eligible for qualitative data. For the primary outcome, Vasopressin or its agonist are associated with a lower AKI incidence (Risk ratio 0.93, 95% CI [0.86, 1.00], P = 0.04, I² = 5%) and a reduced need for renal replacement therapy (Risk ratio 0.84, 95% CI [0.73, 0.97], P = 0.02, I² = 11%). We found no statistical significance in the pooled estimates for the secondary outcomes: RRT free-days (28 or 30 days) (P = 0.65, I² = 0%), 48h creatinine level (P = 0.81, I² = 39%), and 48h urine output (P = 0.46, I² = 8%). Conclusions: Vasopressin and its analogs are associated with a reduced AKI incidence and a lower RRT use rate in septic shock compared to catecholamines. Furthermore, we did not find a significant effect of Vasopressin on the number of RRT- free days (up to 28 or 30 days) or in creatinine level and urinary output in 48 hours. However, due to the high mortality associated with S-AKI, large blinded RCTs addressing renal function impairment in septic shock are warranted.