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Interventions for protecting renal function in the perioperative period
Mathew Zacharias1, Niamh P Conlon, G Peter Herbison
1Department of Anaesthesia & Intensive Care, Dunedin Hospital, Great King Street, Dunedin, Otago, New Zealand, Private Bag 192. 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 and its analogues, 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 that included renal failure and mortality as well as changes in renal function tests, such as 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 2007, Issue 2), MEDLINE (1966 to June, 2007), and EMBASE (1988 to June, 2007); and handsearched six journals (Anesthesia and Analgesia, Anesthesiology, Annals of Surgery, British Journal of Anaesthesia, Journal of Thoracic and Cardiovascular Surgery, and Journal of Vascular Surgery).
Selection Criteria:
We selected all randomized controlled trials in adults undergoing surgery where a treatment measure was used for the purpose of renal protection in the perioperative period.
Data Collection And Analysis:
We selected 53 studies for inclusion in this review. As well as data analysis from all the studies, we performed subgroup analysis for type of intervention, type of surgical procedure, and pre-existing renal dysfunction. We undertook sensitivity analysis on studies with high and moderately good methodological quality.
Main Results:
The review included data from 53 studies, comprising a total of 2327 participants. Of these, 1293 received some form of treatment and 1034 acted as controls. The interventions mostly consisted of different pharmaceutical agents, such as dopamine and its analogues, diuretics, calcium channel blockers, ACE inhibitors, or selected hydration fluids. The results indicated that certain interventions showed minimal benefits. All the results suffered from significant heterogeneity. Hence we cannot draw conclusions about the effectiveness of these interventions in protecting patients' kidneys during surgery.
Authors' Conclusions:
There is no reliable evidence from the available literature to suggest that interventions during surgery can protect the kidneys from damage. There is a need for more studies with high methodological quality. One particular area for further study may be patients with pre-existing renal dysfunction undergoing surgery.
Insights
Current surgical interventions show no 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 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.
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