Pharmacological interventions for protecting renal function after cardiac surgery: a Bayesian network meta‐analysis of comparative effectiveness

Abstract

Many drugs have been investigated as potentially protective of renal function after cardiac surgery. However, their comparative effectiveness has not been established. We performed an arm-based hierarchical Bayesian network meta-analysis including 95 randomised controlled trials with 28,833 participants, which allowed us to compare some agents not previously compared directly. Renal outcomes, including: the incidence of postoperative renal dysfunction and haemodialysis; serum creatinine level at 24 hours postoperatively; all-cause mortality; and length of hospital and ICU stay, were compared. Exploratory meta-regression was conducted for potential effect modifiers. A random effects model was selected according to the evaluation of model fit by deviance information criteria. Atrial natriuretic peptide (odds ratio (95%CrI) 0.28 (0.17-0.48); moderate-quality evidence), B-type natriuretic peptide, dexmedetomidine, levosimendan and N-acetyl cysteine significantly decreased the rate of postoperative renal dysfunction compared with placebo. Atrial natriuretic peptide (OR (95%CrI) 0.24 (0.10-0.58); low-quality evidence), B-type natriuretic peptide, and dexamethasone significantly decreased the need for haemodialysis. Levosimendan significantly decreased mortality, OR (95%CrI) 0.49 (0.27-0.91); low-quality evidence). The benefit of atrial natriuretic peptide was still apparent when baseline renal function was normal. None of the potential effect modifiers were significantly correlated with our renal outcomes. Atrial natriuretic peptide was ranked best regarding renal dysfunction, haemodialysis and length of hospital stay. Levosimendan was ranked best regarding mortality and ICU stay. However, our results should be interpreted cautiously given the assumptions made about transitivity and consistency.

Effects of intraoperative dexmedetomidine on the incidence of acute kidney injury in pediatric cardiac surgery patients: A randomized controlled trial

“…A growing body of literature in animal studies suggest the effects of dexmedetomidine on major organ protection are due to diminishing ischemic injury and reduced systemic inflammatory response in various conditions 28 . Previous studies have reported that dexmedetomidine has a renoprotective effect in adult patients undergoing cardiac surgery under CPB 7,8,29 . However, studies that have focused on the effects of dexmedetomidine in pediatric patients are limited.…”

“…Recent studies have focused on the ability of a number of pharmacological interventions to reduce AKI. Results from these studies demonstrated that the incidence of postoperative renal dysfunction in adults was considerably reduced following treatment with B‐type natriuretic peptide, dexmedetomidine, levosimendan, and N‐acetyl cysteine, compared with the incidence of renal dysfunction in adults who received placebo 7 . Among them, dexmedetomidine has recently received attention.…”

Dexmedetomidine sedation experience in hybrid cardiac operations. Article

“…Данную находку можно объяснить нефропротекторными свойствами дексмедетомидина. Многие коллеги отмечали снижение числа острого почечного повреждения у пациентов в кардиохирургии, где применялся дексмедетомидин [26,27].…”

If there is a 50‐50 chance that something is correct, then nine times out of ten it will be… Bayesian network meta‐analyses in Anaesthesia

“…). Kim et al have reviewed 13 drugs, including atrial natriuretic peptide, dopamine, statins and dexamethasone for renal protection during cardiac surgery. It is unrealistic to expect that all these drugs would have been evaluated against each other in head‐to‐head trials, or that any one trial would have simultaneously compared all 13 drugs.…”