Original InvestigationPathogenesis and Treatment of Kidney DiseaseAcute Kidney Injury and Prognosis After Cardiopulmonary Bypass: A Meta-analysis of Cohort Studies
Section snippets
Study Protocol
This systematic review and meta-analysis was conducted using a prespecified protocol and according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA).6
Search Strategy and Selection Criteria
We searched MEDLINE and EMBASE without language restriction for January 1, 2004, to June 2, 2014, using the following medical subject heading (MeSH) terms: acute kidney injury, renal failure, renal replacement therapy, dialysis, cardiac surgical procedure, cardiopulmonary bypass, coronary artery bypass, mortality,
Description of Included Studies and Participants
The systematic search identified 3,618 citations, of which 320 were retrieved for full-text examination after review by title and abstract. Overall, 46 studies reporting on 47 cohorts comprising 242,388 patients (Fig 1; Table 1) were eligible and included in the review. Sample size varied from 68 to 28,220 (median, 1,610) participants (Table 1). There were 45 cohorts adjusted for covariates reporting at least one of early or late mortality outcomes. Data were extractable for the association
Discussion
This meta-analysis including 242,000 patients at risk of AKI after CPB highlights the prognostic importance of AKI. Adults experiencing CPB-associated AKI experienced markedly increased premature mortality following surgery. Importantly, differing consortia- or guideline-based definitions for AKI provided similar prognostic information about CPB-associated AKI for early death in this clinical setting. Markedly increased risks of death with CPB-associated AKI persisted even when inconsistencies
Acknowledgements
We thank the multiple authors who responded to our requests for additional information.
Support: None.
Financial Disclosure: Dr Pickering has undertaken consultancy for AMPharma. The other authors declare that they have no relevant financial interests.
Contributions: Research idea and study design: JWP, SCP, MJ; data acquisition: JWP; data analysis/interpretation: JWP, SCP, MJ; statistical analysis: JWP. Each author contributed important intellectual content during manuscript drafting or revision
References (77)
- et al.
Meta-analysis in clinical trials
Control Clin Trials
(1986) - et al.
Synthesis of observational studies should consider credibility ceilings
J Clin Epidemiol
(2009) - et al.
Impact of recovery of renal function on long-term mortality after coronary artery bypass grafting
Am J Cardiol
(2010) - et al.
Impact of early and delayed stroke on in-hospital and long-term mortality after isolated coronary artery bypass grafting
Am J Cardiol
(2008) - et al.
Acute kidney injury after coronary artery bypass grafting and long-term risk of myocardial infarction and death
Int J Cardiol
(2014) - et al.
Risks and outcomes of acute kidney injury requiring dialysis after cardiac transplantation
Am J Kidney Dis
(2006) - et al.
GFR shot by RIFLE: errors in staging acute kidney injury
Lancet
(2009) - et al.
Long-term risk of mortality and other adverse outcomes after acute kidney injury: a systematic review and meta-analysis
Am J Kidney Dis
(2009) - et al.
Clinical and angiographic correlates of short- and long-term mortality in patients undergoing coronary artery bypass grafting
Am J Cardiol
(2007) - et al.
Incorporating oliguria into the diagnostic criteria for acute kidney injury after on-pump cardiac surgery: impact on incidence and outcomes
J Cardiothorac Vasc Anesth
(2013)
Survival after isolated coronary artery bypass grafting in patients with severe left ventricular dysfunction
Ann Thorac Surg
Incidence, dynamics, and prognostic value of acute kidney injury for death after cardiac surgery
J Thorac Cardiovasc Surg
Preoperative anemia in patients undergoing coronary artery bypass grafting predicts acute kidney injury
J Thorac Cardiovasc Surg
Renal failure after cardiac surgery: timing of cardiac catheterization and other perioperative risk factors
Ann Thorac Surg
The impact of acute kidney injury on midterm outcomes after coronary artery bypass graft surgery: a matched propensity score analysis
J Thorac Cardiovasc Surg
Acute kidney injury and long-term risk of stroke after coronary artery bypass surgery
Int J Cardiol
Implementation of an intraoperative glycemic control protocol for cardiac surgery in a high-acuity academic medical center: an observational study
J Clin Anesth
Minimal changes in postoperative creatinine values and early and late mortality and cardiovascular events after coronary artery bypass grafting
Am J Cardiol
Postoperative renal dysfunction and preoperative left ventricular dysfunction predispose patients to increased long-term mortality after coronary artery bypass graft surgery
Br J Anaesth
Renal injury is associated with operative mortality after cardiac surgery for women and men
J Thorac Cardiovasc Surg
Predicting hospital mortality and analysis of long-term survival after major noncardiac complications in cardiac surgery patients
Ann Thorac Surg
Ventilator-associated pneumonia is an important risk factor for mortality after major cardiac surgery
J Crit Care
Early and late outcomes of cardiac surgery in octogenarians
Ann Thorac Surg
Acute renal failure in critically ill patients—a multinational, multicenter study
JAMA
World incidence of AKI: A meta-analysis
Clin J Am Soc Nephrol
Acute renal failure—definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group
Crit Care
Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury
Crit Care
Clinical practice guideline for acute kidney injury section 2: AKI definition
Kidney Int Suppl
The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration
Plos Med
What's the relative risk? A method of correcting the odds ratio in cohort studies of common outcomes
JAMA
Estimability and estimation in case-referent studies
Am J Epidemiol
Measuring inconsistency in meta-analyses
BMJ
Interpretation of random effects meta-analyses
BMJ
WHO definition of region groupings
Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration
Plos Med
A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation
Ann Intern Med
Prediction of creatinine clearance from serum creatinine
Nephron
Immediate postoperative renal function deterioration in cardiac surgical patients predicts in-hospital mortality and long-term survival
J Am Soc Nephrol
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