Interventions for protecting renal function in the perioperative period

Area of Science:

• Nephrology
• Surgical Care
• Evidence-Based Medicine

Background:

• Various methods, including dopamine analogues, diuretics, calcium channel blockers, ACE inhibitors, and hydration fluids, have been explored to preserve kidney function during surgery.
• The perioperative period is critical for renal health, with numerous interventions investigated for renal protection.

Purpose of the Study:

• To review randomized controlled trials (RCTs) evaluating different perioperative methods for renal protection.
• To assess outcomes such as renal failure, mortality, and changes in renal function tests.

Main Methods:

• Systematic review of RCTs identified through comprehensive database searches (Cochrane CENTRAL, MEDLINE, EMBASE) and hand-searched journals.
• Inclusion criteria focused on adult surgical patients receiving interventions for perioperative renal protection.
• Data from 53 studies involving 2327 participants were analyzed, with subgroup and sensitivity analyses performed.

Main Results:

• Interventions, primarily pharmaceutical agents and hydration fluids, demonstrated minimal benefits in protecting kidneys during surgery.
• Significant heterogeneity was observed across all studies, limiting definitive conclusions.
• The effectiveness of current interventions in preventing surgical kidney damage remains uncertain.

Conclusions:

• There is a lack of reliable evidence supporting the efficacy of perioperative interventions for renal protection during surgery.
• Further high-quality research is essential, particularly focusing on surgical patients with pre-existing renal dysfunction.