Ioannis Bellos1, Dimitrios C Iliopoulos2, Despina N Perrea2. 1. Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Athens University Medical School, National and Kapodistrian University of Athens, 15Β, Ag. Thoma str., 115 27, Athens, Greece. bellosg@windowslive.com. 2. Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Athens University Medical School, National and Kapodistrian University of Athens, 15Β, Ag. Thoma str., 115 27, Athens, Greece.
Abstract
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.
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.
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