Abstract
Since the first international web-based Consensus Conference on mortality reduction in patients with or at risk for acute kidney injury was held, 13 more papers, dealing with ten interventions, have been published in a peer-reviewed journal showing a statistical significant effect on survival in this subset of patients. Seven interventions increased survival: preoperative renin-angiotensin system inhibitors and aspirin, aprotinin, and sedation with dexmedetomidine in cardiac surgery, continuous renal replacement therapy (CRRT) before and after percutaneous coronary intervention (PCI), angiotensin-converting enzyme inhibitors, and high-volume hemofiltration in severe acute pancreatitis. Three interventions increased mortality: fluid overload, high-volume hydration before PCI, and prophylactic sodium bicarbonate in cardiac surgery. However, the overall quality of these studies was low. Only two interventions (CRRT before PCI and fluid overload) were already included in the Consensus Conference, and the new studies identified may strengthen their role in affecting mortality. The others represent new hints for future research.
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References
Landoni G, Bove T, Székely A et al (2013) Reducing mortality in acute kidney injury patients: systematic review and international web-based survey. J Cardiothorac Vasc Anesth 27:1384–1398
Bellomo R, Weinberg L (2012) Web-enabled democracy-based consensus in perioperative medicine: sedation or solution? J Cardiothorac Vasc Anesth 26:762–763
Greco M, Zangrillo A, Mucchetti M et al (2015) Democracy-based consensus in medicine. J Cardiothorac Vasc Anesth 29:506–509
Shi P, Li Z, Young N et al (2013) The effect of preoperative renin-angiotensin system inhibitors on outcomes in patients undergoing cardiac surgery. J Cardiothorac Vasc Anesth 27:703–709
Yao L, Young N, Liu H et al (2015) Evidence for preoperative aspirin improving major outcomes in patients with chronic kidney disease undergoing cardiac surgery: a cohort study. Ann Surg 261:207–212
Walkden GJ, Verheyden V, Goudie R et al (2013) Increased perioperative mortality following aprotinin withdrawal: a real-world analysis of blood management strategies in adult cardiac surgery. Intensive Care Med 39:1808–1817
Ji F, Li Z, Young N et al (2013) Post-bypass dexmedetomidine use and postoperative acute kidney injury in patients undergoing cardiac surgery with cardiopulmonary bypass. PLoS ONE 8:e77446
Spini V, Cecchi E, Chiostri M et al (2013) Effects of two different treatments with continuous renal replacement therapy in patients with chronic renal dysfunction submitted to coronary invasive procedures. J Invasive Cardiol 25:80–84
Wang AI, Bellomo R, Ninomiya T et al (2014) Angiotensin-converting enzyme inhibitor usage and acute kidney injury: a secondary analysis of RENAL study outcomes. Nephrology 19:617–622
Guo J, Huang W, Yang XN et al (2014) Short-term continuous high-volume hemofiltration on clinical outcomes of severe acute pancreatitis. Pancreas 43:250–254
Bellomo R, Cass A, Cole L et al (2012) An observational study fluid balance and patients outcomes in the randomized evaluation of normal vs. augmented level of replacement therapy trial. Crit Care Med 40:1753–1760
Vaara ST, Korhonen AM, Kaukonen KM et al (2012) Fluid overload is associated with an increased risk for 90-day mortality in critically ill patients with renal replacement therapy: data from the prospective FINNAKI study. Crit Care 16:R197
Silversides JA, Pinto R, Kuint R et al (2014) Fluid balance, intradialytic hypotension, and outcomes in critically ill patients with renal replacement therapy. Crit Care 18:624
Zhang L, Chen Z, Diao Y et al (2015) Association of fluid overload with mortality and kidney recovery in patients with acute kidney injury: a systematic review and meta-analysis. J Crit Care 30:860e7–860e13
Manari A, Magnavacchi P, Puggioni E et al (2014) Acute kidney injury after primary angioplasty: effect of different hydration treatments. J Cardiovasc Med 15:60–67
Haase M, Haase-Fielitz A, Plass M et al (2013) Prophylactic perioperative sodium bicarbonate to prevent acute kidney injury following open heart surgery: a multicenter double-blinded randomized controlled trial. PLoS Med 10:e1001426
Garg AX, Kurz A, Sessler DI et al (2014) Perioperative aspirin and clonidine and risk of acute kidney injury: a randomized clinical trial. JAMA 12:2254–2264
Fergusson DA, Hébert PC, Mazer CD et al (2008) A comparison of aprotinin and lysine analogues in high-risk cardiac surgery. N Engl J Med 29(358):2319–2331
The RENAL Replacement Therapy Study Investigators (2009) Intensity of continuous renal replacement therapy in critically ill patients. N Engl J Med 361:1627–1638
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Mucchetti, M., Masserini, F., Verniero, L. (2016). Reducing Mortality in Patients with Acute Kidney Injury: A Systematic Update. In: Landoni, G., Pisano, A., Zangrillo, A., Bellomo, R. (eds) Reducing Mortality in Acute Kidney Injury. Springer, Cham. https://doi.org/10.1007/978-3-319-33429-5_22
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DOI: https://doi.org/10.1007/978-3-319-33429-5_22
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