Off-Pump Coronary Artery Bypass Surgery and Acute Kidney Injury: A Meta-Analysis of Randomized Controlled Trials

被引:96
作者
Seabra, Victor F. [1 ,3 ]
Alobaidi, Sami [1 ]
Balk, Ethan M. [2 ,3 ]
Poon, Alan H. [1 ]
Jaber, Bertrand L. [1 ,3 ]
机构
[1] St Elizabeths Med Ctr, Kidney & Dialysis Res Lab, Div Nephrol, Dept Med, Boston, MA 02135 USA
[2] Tufts Univ, Tufts Clin & Translat Sci Inst, Ctr Clin Evidence Synth, Boston, MA 02111 USA
[3] Tufts Univ, Sch Med, Dept Med, Boston, MA 02111 USA
来源
CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY | 2010年 / 5卷 / 10期
基金
美国国家卫生研究院;
关键词
ACUTE-RENAL-FAILURE; ON-PUMP; CARDIOPULMONARY BYPASS; BEATING-HEART; MYOCARDIAL REVASCULARIZATION; TRANSFUSION REQUIREMENTS; INFLAMMATORY RESPONSE; SHORT-TERM; MORTALITY; OUTCOMES;
D O I
10.2215/CJN.02800310
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Background and objectives: Off-pump coronary artery bypass grafting (CABG) has been advocated to cause less inflammation, morbidity, and mortality than the more traditional on-pump technique. This meta-analysis compares these two surgical techniques with respect to causing acute kidney injury (AKI). Design, setting, participants, & measurements: This study searched for randomized controlled trials in MEDLINE and abstracts from the proceedings of scientific meetings through February 2010. Included were trials comparing off-pump to on-pump CABG that reported the incidence of AKI, as defined by a mixture of criteria including biochemical parameter/urine output/dialysis requirement. Mortality was evaluated among the studies that reported kidney-related outcomes. For primary and subgroup analyses, fixed-effect meta-analyses of odds ratios (OR) were performed. Results: In 22 identified trials (4819 patients), the weighted incidence of AKI in the on-pump CABG group was 4.0% (95% confidence interval 1.8%, 8.5%), dialysis requirement 2.4% (95% CI 1.6%, 3.7%), and mortality 2.6% (95% CI 1.6%, 4.0%). By meta-analysis, off-pump CABG was associated with a 40% lower odds of postoperative AKI (OR 0.60; 95% CI 0.43, 0.84; P = 0.003) and a nonsignificant 33% lower odds for dialysis requirement (OR 0.67; 95% CI 0.40, 1.12; P = 0.12). Within the selected trials, off-pump CABG was not associated with a significant decrease in mortality. Conclusions: Off-pump CABG may be associated with a lower incidence of postoperative AKI but may not affect dialysis requirement, a serious complication of cardiac surgery. However, the different definitions of AKI used in individual trials and methodological concerns preclude definitive conclusions. Clin J Am Soc Nephrol 5: 1734-1744, 2010. doi: 10.2215/CJN.02800310
引用
收藏
页码:1734 / 1744
页数:11
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