Pharmacological interventions for the prevention of acute kidney injury after pediatric cardiac surgery: a network meta-analysis

• Published in: Clinical and experimental nephrology 2019-06, Vol.23 (6), p.782-791
• Main Authors: Bellos, Ioannis, Iliopoulos, Dimitrios C., Perrea, Despina N.
• Format: Article
• Language: English
• Subjects: Acetaminophen; Acute Kidney Injury - etiology; Acute Kidney Injury - prevention & control; Analgesics; Cardiac Surgical Procedures - adverse effects; Child; Clinical trials; Corticosteroids; Heart diseases; Heart surgery; Humans; Kidneys; Medicine; Medicine & Public Health; Meta-analysis; Nephrology; Network Meta-Analysis; Original Article; Pediatrics; Postoperative Complications - etiology; Postoperative Complications - prevention & control; Protective Agents - therapeutic use; Renal function; Statistical analysis; Urology
• ISSN: 1342-1751; 1437-7799
• DOI: 10.1007/s10157-019-01706-9

Background Acute kidney injury constitutes a major complication of cardiac surgery in pediatric patients. The present meta-analysis aims to accumulate current literature and assess the efficacy of pharmacological interventions in preventing postoperative renal dysfunction after congenital heart surgery. Methods Literature search was conducted using Medline (1966–2018), Scopus (2004–2018), Cochrane Central Register of Controlled Trials CENTRAL (1999–2018), Clinicaltrials.gov (2008–2018), and Google Scholar (2004–2018) databases. Statistical analysis was performed with Review Manager 5.3 and R 3.4.3. Results Meta-analysis included 14 studies, with a total of 2,625 patients. AKI incidence was significantly lower in the dexmedetomidine (OR 0.49, 95% CI [0.28–0.87]) and acetaminophen (OR 0.43, 94% CI [0.28–0.67]) groups, while no difference was present in patients receiving corticosteroid (OR 1.16, 95% CI [0.69–1.95]), fenoldopam (OR 0.47, 95% CI [0.22–1.02]), or aminophylline (OR 0.98, 95% CI [0.29–3.34]). Network meta-analysis proposed that dexmedetomidine had the greatest probability (44.5%) to rank first, although significant overlap with the other treatments was observed. Conclusions The present meta-analysis suggests that no firm evidence exists about the protective role of pharmacological interventions in the pediatric population. Future randomized controlled trials should clarify the effectiveness of dexmedetomidine and acetaminophen and indicate the optimal protocol to be applied, to protect renal function in the perioperative setting.