Related Experiment Video
Updated: Oct 17, 2025
A Large Animal Model for Acute Kidney Injury by Temporary Bilateral Renal Artery Occlusion
Published on: February 2, 2021
Strategies to Prevent Acute Kidney Injury after Pediatric Cardiac Surgery: A Network Meta-Analysis
Jef Van den Eynde1,2, Nicolas Cloet2, Robin Van Lerberghe2
1Helen B. Taussig Heart Center, The Johns Hopkins Hospital and School of Medicine, Baltimore, Maryland.
Insights
Preventing acute kidney injury (AKI) after pediatric cardiac surgery remains challenging. Current evidence shows limited efficacy for most strategies, with some promising but inconclusive results for dexmedetomidine and remote ischemic preconditioning.
Area of Science:
- Pediatric Cardiology
- Nephrology
- Critical Care Medicine
Background:
- Acute kidney injury (AKI) is a frequent complication following pediatric cardiac surgery.
- AKI is associated with increased morbidity and mortality in this vulnerable population.
Purpose of the Study:
- To compare the effectiveness of various pharmacologic and non-pharmacologic interventions for preventing AKI in pediatric cardiac surgery patients.
- To synthesize current evidence from randomized controlled trials (RCTs) on AKI prevention strategies.
Main Methods:
- Systematic search of major databases (PubMed/MEDLINE, Embase, Cochrane) for RCTs up to August 2020.
- Performed random effects traditional pairwise meta-analyses, Bayesian network meta-analyses, and trial sequential analyses.
- Included 20 RCTs with 2339 pediatric patients and 11 distinct preventive strategies.
Main Results:
- Traditional meta-analysis found no significant differences for corticosteroids, fenoldopam, hydroxyethyl starch, or remote ischemic preconditioning versus control.
- Trial sequential analysis indicated potential risk reduction with dexmedetomidine (80%) and remote ischemic preconditioning (<57%).
- Network meta-analysis did not show significant differences among all examined treatments; milrinone, dexmedetomidine, and levosimendan showed highest probabilities for AKI risk reduction.
Conclusions:
- Existing RCT evidence does not strongly support most strategies for preventing AKI in pediatric cardiac surgery.
- Limited evidence suggests potential benefits of dexmedetomidine and remote ischemic preconditioning, warranting further investigation.
- Further high-quality research is needed to establish effective AKI prevention protocols in this patient group.
Background And Objectives:
AKI is a common complication after pediatric cardiac surgery and has been associated with higher morbidity and mortality. We aimed to compare the efficacy of available pharmacologic and nonpharmacologic strategies to prevent AKI after pediatric cardiac surgery.
Design, Setting, Participants, & Measurements:
PubMed/MEDLINE, Embase, Cochrane Controlled Trials Register, and reference lists of relevant articles were searched for randomized controlled trials from inception until August 2020. Random effects traditional pairwise, Bayesian network meta-analyses, and trial sequential analyses were performed.
Results:
Twenty randomized controlled trials including 2339 patients and 11 preventive strategies met the eligibility criteria. No overall significant differences were observed compared with control for corticosteroids, fenoldopam, hydroxyethyl starch, or remote ischemic preconditioning in traditional pairwise meta-analysis. In contrast, trial sequential analysis suggested a 80% relative risk reduction with dexmedetomidine and evidence of <57% relative risk reduction with remote ischemic preconditioning. Nonetheless, the network meta-analysis was unable to demonstrate any significant differences among the examined treatments, including also acetaminophen, aminophylline, levosimendan, milrinone, and normothermic cardiopulmonary bypass. Surface under the cumulative ranking curve probabilities showed that milrinone (76%) was most likely to result in the lowest risk of AKI, followed by dexmedetomidine (70%), levosimendan (70%), aminophylline (59%), normothermic cardiopulmonary bypass (57%), and remote ischemic preconditioning (55%), although all showing important overlap.
Conclusions:
Current evidence from randomized controlled trials does not support the efficacy of most strategies to prevent AKI in the pediatric population, apart from limited evidence for dexmedetomidine and remote ischemic preconditioning.
Related Concept Videos
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention
01:20Acute Kidney Injury V: Interprofessional Care
01:22Acute Kidney Injury VI: Nursing Management
01:22Acute Kidney Injury I: Introduction
01:29Acute Kidney Injury II: Pathophysiology
01:28Cardiac Catheterization I: Pre-Procedure Overview