Remote ischemic preconditioning (RIPC) may attenuate acute kidney injury (AKI). However, results of studies evaluating the effect of RIPC on AKI after cardiac surgery have been controversial and contradictory.The aim of this meta-analysis is to examine the association between RIPC and AKI after on-pump cardiac surgery.The authors searched relevant studies in PubMed, EMBASE, and the Cochrane Library through December 2015.We considered for inclusion all randomized controlled trials that the role of RIPC in reducing AKI and renal replacement therapy (RRT) among patients underwent on-pump cardiac surgical procedures.We collected the data on AKI, initiation of RRT, serum creatinine (sCr) levels, and in-hospital mortality. Random- and fixed-effect models were used for pooling data.Nineteen trials including 5100 patients were included. The results of this meta-analysis showed a significant benefit of RIPC for reducing the incidence of AKI after cardiac interventions (odds ratio [OR] = 0.84; 95% confidence interval [CI], 0.73–0.98; P = 0.02). No significant difference was found in the incidence of RRT between RIPC and control (OR, 0.76, 95% CI, 0.46–1.24; P = 0.36). In addition, compared with standard medical care, RIPC showed no significant difference in postoperative sCr (IV 0.07; 95% CI, −0.03 to 0.16; P = 0.20; postoperative day 1; IV 0.00; 95% CI, −0.08 to 0.09; P = 0.92; postoperative day 2; IV 0.04; 95% CI, −0.05 to 0.12; P = 0.39; postoperative day 3), and in-hospital mortality (OR, 1.21, 95% CI, 0.64–2.30; P = 0.56).According to the results from present meta-analysis, RIPC was associated with a significant reduction AKI after on-pump cardiac surgery but incidence of RRT, postoperative sCr, and in-hospital mortality. Further high-quality randomized controlled trials and experimental researches comparing RIPC are desirable.
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机译:远程缺血预处理(RIPC)可以减轻急性肾损伤(AKI)。然而,评估RIPC对心脏手术后AKI的疗效的研究结果存在争议和矛盾。本荟萃分析的目的是探讨心脏泵手术后RIPC与AKI之间的相关性。截至2015年12月,PubMed,EMBASE和Cochrane图书馆均纳入了所有随机对照试验,其中包括RIPC在减少接受心脏泵手术的患者中AKI和肾替代疗法(RRT)中的作用。 AKI,RRT的启动,血清肌酐(sCr)水平和院内死亡率。随机和固定效应模型用于汇总数据,包括19个试验,包括5100名患者。这项荟萃分析的结果显示,RIPC可以显着降低心脏干预后AKI的发生率(几率[OR] = 0.84; 95%置信区间[CI],0.73-0.98; P = 0.02)。 RIPC与对照组之间的RRT发生率无显着差异(OR,0.76,95%CI,0.46-1.24; P = 0.36)。此外,与标准医疗相比,RIPC术后sCr差异无统计学意义(IV 0.07; 95%CI,-0.03至0.16; P =; 0.20;术后1天; IV 0.00; 95%CI,-0.08至0.09; IV:0.00。 P = 0.92;术后第2天; IV 0.04; 95%CI,-0.05至0.12; P = 0.39;术后3天;以及院内死亡率(OR,1.21,95%CI,0.64-2.30; P = 0.56 )。根据目前的荟萃分析结果,RIPC与心脏泵手术后AKI的显着降低有关,但与RRT的发生率,术后sCr和院内死亡率有关。进一步高质量的随机对照试验和比较RIPC的实验研究是可取的。
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