Related Experiment Video
Updated: Aug 16, 2026
Improved Renal Denervation Mitigated Hypertension Induced by Angiotensin II Infusion
Published on: May 26, 2022
Interventions for protecting renal function in the perioperative period
M Zacharias1, I C S Gilmore, G P Herbison
1Anaesthesia & Intensive Care, Dunedin Hospital, Great King Street, Dunedin, Otago, New Zealand. mathew.zacharias@stonebow.otago.ac.nz
Background:
A number of methods have been used to try to protect kidney function in patients undergoing surgery. These include the administration of dopamine, diuretics, calcium channel blockers, angiotensin converting enzyme inhibitors and hydration fluids.
Objectives:
For this review, we selected randomized controlled trials, which employed different methods to protect renal function during the perioperative period. In examining these trials, we looked at outcomes such as renal failure and mortality, as well as changes in the renal function tests, including urine output, creatinine clearance, free water clearance, fractional excretion of sodium and renal plasma flow.
Search Strategy:
We searched the Cochrane Central register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 4, 2004), MEDLINE (1966 to 2004) and EMBASE (1988 to 2004) and hand searched six journals (British Journal of Anaesthesia; Anesthesia and Analgesia; Anesthesiology; Annals of Surgery; Journal of Thoracic and Cardiovascular Surgery and Journal of Vascular Surgery).
Selection Criteria:
We selected all randomized controlled trials in adult population undergoing surgery where a treatment measure was used for the purpose of renal protection in the perioperative period.
Data Collection And Analysis:
We selected 37 studies for inclusion in this review. As well as analysis of the data from all the studies, we also performed subgroup analysis for type of interventions, types of surgical procedures and those with pre-existing renal dysfunction. We undertook sensitivity analysis on studies with high methodological quality.
Main Results:
The review included data from 37 studies, comprising a total of 1227 patients. Of these, 658 received some form of treatment and 569 acted as controls. The interventions were mostly employing different pharmaceutical agents such as dopamine, diuretics, calcium channel blockers. ACE inhibitors or selected hydration fluids. The results indicated that certain interventions showed some benefits, but all the results suffered from significant heterogeneity. Hence we can draw no conclusions about the effectiveness of these interventions in protecting the kidneys during surgery.
Authors' Conclusions:
There is no reliable evidence from available literature to suggest that interventions during surgery can protect the kidneys from damage. However, there is a need for more studies of high methodological quality. One particular area for further studies may be on patients with pre-existing renal dysfunction undergoing surgery.
Insights
Current surgical methods lack reliable evidence for protecting kidney function. More high-quality studies are needed, especially for patients with pre-existing renal dysfunction undergoing surgery.
Area of Science:
- Nephrology
- Surgical Medicine
- Pharmacology
Background:
- Surgical procedures pose a risk to kidney function.
- Various interventions, including dopamine, diuretics, and ACE inhibitors, have been explored for perioperative renal protection.
Purpose of the Study:
- To review randomized controlled trials (RCTs) evaluating methods for protecting renal function during surgery.
- To assess outcomes such as renal failure, mortality, and renal function tests.
Main Methods:
- Systematic search of multiple databases (CENTRAL, MEDLINE, EMBASE) and hand-searched journals.
- Inclusion of 37 RCTs involving adult surgical patients receiving perioperative renal protection interventions.
- Subgroup and sensitivity analyses were performed based on intervention type, surgical procedure, and patient renal status.
Main Results:
- Data from 37 studies and 1227 patients were analyzed.
- Interventions included pharmaceutical agents and hydration fluids.
- Significant heterogeneity across studies precluded drawing definitive conclusions on effectiveness.
Conclusions:
- No reliable evidence supports the effectiveness of current surgical interventions in protecting kidneys.
- Further high-quality research is essential, particularly focusing on patients with pre-existing renal dysfunction.
Related Concept Videos
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention
01:20Acute Kidney Injury V: Interprofessional Care
01:16Kidney Transplant III: Nursing Management
01:22Acute Kidney Injury VI: Nursing Management
01:28Chronic Kidney Disease III: Interprofessional Care
01:26Kidney Transplant II: Surgical Procedure