Reducing Mortality in Acute Kidney Injury Patients: Systematic Review and International Web-Based Survey

Landoni, Giovanni; Bove, Tiziana; Székely, Andrea; Comis, Marco; Rodseth, Reitze; Pasero, Daniela; Ponschab, Martin; Mucchetti, Marta; Azzolini, Maria Luisa; Caramelli, Fabio; Paternoster, Gianluca; Pala, Giovanni; Cabrini, Luca; Amitrano, Daniele; Borghi, Giovanni; Capasso, Antonella; Cariello, Claudia; Carpanese, Anna; Feltracco, Paolo; Gottin, Leonardo; Lobreglio, Rosetta; Mattioli, Lorenzo; Monaco, Fabrizio; Morgese, Francesco; Musu, Mario; Pasin, Laura; Pisano, Antonio; Roasio, Agostino; Russo, G.I.; Slaviero, Giorgio; Villari, Nicola; Vittorio, Annalisa; Zucchetti, Martina; Guarracino, Fabio; Morelli, Andrea; Santis, Vincenzo De; Sarto, Paolo A. Del; Corcione, Antonio; Ranieri, Marco; Finco, Gabriele; Zangrillo, Alberto; Bellomo, Rinaldo

doi:10.1053/j.jvca.2013.06.028

Cited by 66 publications

(25 citation statements)

References 79 publications

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“…[4][5][6][7][8] Since evidence seems to be constantly and rapidly evolving, we Page 5 of 39 conducted an update of a previous consensus process on ancillary (nonsurgical) interventions (drugs/techniques/strategies) which have been shown by at least one randomized controlled trial (RCT) or meta-analysis of RCTs to affect perioperative mortality in any adult surgical setting. In addition to a systematic literature search, consensus meeting and web-based survey about the agreement on the included interventions, we investigated the reported use in clinical practice of such interventions and the possible gap between literature evidence and clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Randomized Evidence for Reduction of Perioperative Mortality: An Updated Consensus Process

Landoni

Pisano

Lomivorotov

et al. 2017

Journal of Cardiothoracic and Vascular Anesthesia

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Of the 230 million patients undergoing major surgical procedures every year, more than 1 million will die within 30 days. Thus, any nonsurgical interventions that help reduce perioperative mortality might save thousands of lives. The authors have updated a previous consensus process to identify all the nonsurgical interventions, supported by randomized evidence, that may help reduce perioperative mortality

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Section: Introductionmentioning

confidence: 99%

Randomized Evidence for Reduction of Perioperative Mortality: An Updated Consensus Process

Landoni

Pisano

Lomivorotov

et al. 2017

Journal of Cardiothoracic and Vascular Anesthesia

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“…1 Although the mechanisms of acute kidney injury are not fully understood, injury to renal tubular epithelial cells is a universal aspect of the disease. Despite numerous clinical trials using several interventions, 4 a reliable means to prevent acute kidney injury remains elusive. Remote ischemic preconditioning elicited by brief episodes of ischemia and reperfusion in distant tissue may provide protection from subsequent injury.…”

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confidence: 99%

Effect of Remote Ischemic Preconditioning on Kidney Injury Among High-Risk Patients Undergoing Cardiac Surgery

Zarbock

Schmidt

Aken

et al. 2015

JAMA

340

150

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IMPORTANCE No interventions have yet been identified to reduce the risk of acute kidney injury in the setting of cardiac surgery.OBJECTIVE To determine whether remote ischemic preconditioning reduces the rate and severity of acute kidney injury in patients undergoing cardiac surgery. DESIGN, SETTING, AND PARTICIPANTSIn this multicenter trial, we enrolled 240 patients at high risk for acute kidney injury, as identified by a Cleveland Clinic Foundation score of 6 or higher, between August 2013 and June 2014 at 4 hospitals in Germany. We randomized them to receive remote ischemic preconditioning or sham remote ischemic preconditioning (control). All patients completed follow-up 30 days after surgery and were analyzed according to the intention-to-treat principle.INTERVENTIONS Patients received either remote ischemic preconditioning (3 cycles of 5-minute ischemia and 5-minute reperfusion in one upper arm after induction of anesthesia) or sham remote ischemic preconditioning (control), both via blood pressure cuff inflation. MAIN OUTCOMES AND MEASURESThe primary end point was the rate of acute kidney injury defined by Kidney Disease: Improving Global Outcomes criteria within the first 72 hours after cardiac surgery. Secondary end points included use of renal replacement therapy, duration of intensive care unit stay, occurrence of myocardial infarction and stroke, in-hospital and 30-day mortality, and change in acute kidney injury biomarkers.RESULTS Acute kidney injury was significantly reduced with remote ischemic preconditioning (45 of 120 patients [37.5%]) compared with control (63 of 120 patients [52.5%]; absolute risk reduction, 15%; 95% CI, 2.56%-27.44%; P = .02). Fewer patients receiving remote ischemic preconditioning received renal replacement therapy (7 [5.8%] vs 19 [15.8%]; absolute risk reduction, 10%; 95% CI, 2.25%-17.75%; P = .01), and remote ischemic preconditioning reduced intensive care unit stay (3 days [interquartile range, 2-5]) vs 4 days (interquartile range, 2-7) (P = .04). There was no significant effect of remote ischemic preconditioning on myocardial infarction, stroke, or mortality. Remote ischemic preconditioning significantly attenuated the release of urinary insulinlike growth factor-binding protein 7 and tissue inhibitor of metalloproteinases 2 after surgery (remote ischemic preconditioning, 0.36 vs control, 0.97 ng/mL 2 /1000; difference, 0.61; 95% CI, 0.27-0.86; P < .001). No adverse events were reported with remote ischemic preconditioning.CONCLUSIONS AND RELEVANCE Among high-risk patients undergoing cardiac surgery, remote ischemic preconditioning compared with no ischemic preconditioning significantly reduced the rate of acute kidney injury and use of renal replacement therapy. The observed reduction in the rate of acute kidney injury and the need for renal replacement warrants further investigation.TRIAL REGISTRATION German Clinical Trials Register Identifier: DRKS00005333

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“…However, neither a decrease of mortality [75] nor a better preservation of long-term kidney function has been reported [76]. A recent systematic review and international survey identified several drugs, techniques or strategies that could reduce mortality in patients with or at risk of AKI, as suggested by at least one peer-reviewed manuscript showing statistically significant effect on survival [77].…”

Section: Therapeutic Interventionsmentioning

confidence: 99%

Hepatic and renal effects of cardiopulmonary bypass

Tomasso

Monaco

Landoni

2015

Best Practice & Research Clinical Anaesthesiology

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Reducing Mortality in Acute Kidney Injury Patients: Systematic Review and International Web-Based Survey

Cited by 66 publications

References 79 publications

Randomized Evidence for Reduction of Perioperative Mortality: An Updated Consensus Process

Randomized Evidence for Reduction of Perioperative Mortality: An Updated Consensus Process

Effect of Remote Ischemic Preconditioning on Kidney Injury Among High-Risk Patients Undergoing Cardiac Surgery

Hepatic and renal effects of cardiopulmonary bypass

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