Interventions for protecting renal function in the perioperative period.

Area of Science:

• Nephrology
• Anesthesiology
• Surgical Sciences

Background:

• Numerous methods, including pharmacological agents like dopamine, diuretics, ACE inhibitors, and EPO, have been investigated for perioperative kidney protection.
• These interventions aim to preserve renal function during surgical procedures.

Purpose of the Study:

• To determine the effectiveness of various advocated measures for protecting kidneys during the perioperative period.
• To compare the efficacy and safety of different renal protection methods.

Main Methods:

• Systematic review of randomized controlled trials in adults undergoing surgery.
• Searched Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE databases.
• Included 72 studies with 4378 participants; data extracted and analyzed, with subgroup analyses performed.

Main Results:

• Most interventions showed no significant benefit in protecting against perioperative mortality or acute kidney injury.
• Subgroup analysis for patients with pre-existing renal damage suggested a potential reduction in mortality (OR 0.76) and acute kidney injury (OR 0.43), but with wide confidence intervals.
• Studies with low risk of bias indicated no significant influence of interventions on mortality or acute kidney injury.

Conclusions:

• Current evidence does not reliably support the use of surgical interventions for kidney protection.
• Methodological limitations and varied diagnostic criteria in older studies hinder definitive conclusions.
• Future research should utilize recent biomarkers and standardized criteria (e.g., RIFLE, AKI) to better assess intervention efficacy.