Erythropoietin administration for prevention of cardiac surgery-associated acute kidney injury: a meta-analysis of randomized controlled trials

Tie, Hongtao; Luo, Ming; Lin, Dan; Zhang, Min; Wan, Jingyuan; Wu, Qingchen

doi:10.1093/ejcts/ezu378

Cited by 21 publications

(14 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A recent meta-analysis (5 studies, 423 patients) found no effect of erythropoietin on the incidence of AKI: RR 0.64 (0.35–1.16). Surprisingly, a preplanned subgroup analysis found a significant reduction of AKI in patients without high risk for AKI: RR 0.37 (0.24–0.61; p < 0.0001) [211]. Similar results were obtained in the most recent meta-analysis, which in addition showed more protection with pre-anaesthetic administration [212].…”

Section: Hormonal Manipulationsupporting

confidence: 57%

Prevention of acute kidney injury and protection of renal function in the intensive care unit: update 2017

et al. 2017

View full text Add to dashboard Cite

BackgroundAcute kidney injury (AKI) in the intensive care unit is associated with significant mortality and morbidity.ObjectivesTo determine and update previous recommendations for the prevention of AKI, specifically the role of fluids, diuretics, inotropes, vasopressors/vasodilators, hormonal and nutritional interventions, sedatives, statins, remote ischaemic preconditioning and care bundles.MethodA systematic search of the literature was performed for studies published between 1966 and March 2017 using these potential protective strategies in adult patients at risk of AKI. The following clinical conditions were considered: major surgery, critical illness, sepsis, shock, exposure to potentially nephrotoxic drugs and radiocontrast. Clinical endpoints included incidence or grade of AKI, the need for renal replacement therapy and mortality. Studies were graded according to the international GRADE system.ResultsWe formulated 12 recommendations, 13 suggestions and seven best practice statements. The few strong recommendations with high-level evidence are mostly against the intervention in question (starches, low-dose dopamine, statins in cardiac surgery). Strong recommendations with lower-level evidence include controlled fluid resuscitation with crystalloids, avoiding fluid overload, titration of norepinephrine to a target MAP of 65–70 mmHg (unless chronic hypertension) and not using diuretics or levosimendan for kidney protection solely.ConclusionThe results of recent randomised controlled trials have allowed the formulation of new recommendations and/or increase the strength of previous recommendations. On the other hand, in many domains the available evidence remains insufficient, resulting from the limited quality of the clinical trials and the poor reporting of kidney outcomes.Electronic supplementary materialThe online version of this article (doi:10.1007/s00134-017-4832-y) contains supplementary material, which is available to authorized users.

show abstract

Section: Hormonal Manipulationsupporting

confidence: 57%

Prevention of acute kidney injury and protection of renal function in the intensive care unit: update 2017

et al. 2017

View full text Add to dashboard Cite

show abstract

“…A meta-analysis with patients at risk for AKI showed no benefit of ESAs on incidence of AKI [58]. Another meta-analyses of effects of ESAs on CKD patients also showed no clear benefit on progression to RRT, comparing ESA treatment to no treatment [59] or comparing high vs low Hb targets [60, 61], nor was there was an association between ESA dose and annual GFR change or progression to ESRD [62].…”

Section: Discussionmentioning

confidence: 99%

Erythropoiesis stimulating agents and reno-protection: a meta-analysis

2017

View full text Add to dashboard Cite

BackgroundErythropoiesis stimulating agents (ESAs) were proposed to enhance survival of renal tissues through direct effects via activation of EPO receptors on renal cells resulting in reduced cell apoptosis, or indirect effects via increased oxygen delivery due to increased numbers of Hb containing red blood cells. Thus through several mechanisms there may be benefit of ESA administration on kidney disease progression and kidney function in renal patients. However conflicting ESA reno-protection outcomes have been reported in both pre-clinical animal studies and human clinical trials. To better understand the potential beneficial effects of ESAs on renal-patients, meta-analyses of clinical trials is needed.MethodsLiterature searches and manual searches of references lists from published studies were performed. Controlled trials that included ESA treatment on renal patients with relevant renal endpoints were selected.ResultsThirty two ESA controlled trials in 3 categories of intervention were identified. These included 7 trials with patients who had a high likelihood of AKI, 7 trials with kidney transplant patients and 18 anemia correction trials with chronic kidney disease (predialysis) patients. There was a trend toward improvement in renal outcomes in the ESA treated arm of AKI and transplant trials, but none reached statistical significance. In 12 of the anemia correction trials, meta-analyses showed no difference in renal outcomes with the anemia correction but both arms received some ESA treatment making it difficult to assess effects of ESA treatment alone. However, in 6 trials the low Hb arm received no ESAs and meta-analysis also showed no difference in renal outcomes, consistent with no benefit of ESA/ Hb increase.ConclusionsMost ESA trials were small with modest event rates. While trends tended to favor the ESA treatment arm, these meta-analyses showed no reduction of incidence of AKI, no reduction in DGF or improvement in 1-year graft survival after renal transplantation and no significant delay in progression of CKD. These results do not support significant clinical reno-protection by ESAs.

show abstract

“…Perioperative. Numerous pharmacological agents including levosimendan, [94][95][96][97] statins, 98-100 N-acetylcysteine, [101][102][103][104] sodium bicarbonate, [105][106][107][108] and erythropoietin [109][110][111][112][113] have, for the most part, failed to demonstrate benefit for the prevention of CS-AKI. A possible exception is dexmedetomidine, for which a number of small or low-quality studies found a reduction in the occurrence of AKI after cardiac surgery.…”

Section: Pharmacological Strategiesmentioning

confidence: 99%

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

Nadim

Forni

Bïhorac

et al. 2018

JAHA

228

191

View full text Add to dashboard Cite

Erythropoietin administration for prevention of cardiac surgery-associated acute kidney injury: a meta-analysis of randomized controlled trials

Cited by 21 publications

References 34 publications

Prevention of acute kidney injury and protection of renal function in the intensive care unit: update 2017

Prevention of acute kidney injury and protection of renal function in the intensive care unit: update 2017

Erythropoiesis stimulating agents and reno-protection: a meta-analysis

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

Contact Info

Product

Resources

About