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Intervention Review

Interventions for protecting renal function in the perioperative period

  1. Mathew Zacharias1,*,
  2. Niamh P Conlon2,
  3. G Peter Herbison3,
  4. Pal Sivalingam4,
  5. Robert J Walker5,
  6. Karen Hovhannisyan6

Editorial Group: Cochrane Anaesthesia Group

Published Online: 8 OCT 2008

Assessed as up-to-date: 24 JUN 2007

DOI: 10.1002/14651858.CD003590.pub3


How to Cite

Zacharias M, Conlon NP, Herbison GP, Sivalingam P, Walker RJ, Hovhannisyan K. Interventions for protecting renal function in the perioperative period. Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No.: CD003590. DOI: 10.1002/14651858.CD003590.pub3.

Author Information

  1. 1

    Dunedin Hospital, Department of Anaesthesia & Intensive Care, Dunedin, Otago, New Zealand

  2. 2

    Duke University Medical Center, Department of Cardiothoracic Anesthesiology , Durham, North Carolina, USA

  3. 3

    Dunedin School of Medicine, University of Otago, Department of Preventive & Social Medicine, Dunedin, New Zealand

  4. 4

    Princess Alexandria Hospital, Department of Anaesthesia & Intensive Care, Brisbane, Australia

  5. 5

    University of Otago, Department of Medical & Surgical Sciences, Dunedin, New Zealand

  6. 6

    Rigshospitalet, The Cochrane Anaesthesia Review Group, København , Denmark

*Mathew Zacharias, Department of Anaesthesia & Intensive Care, Dunedin Hospital, Great King Street, Dunedin, Otago, Private Bag 192, New Zealand. mathew.zacharias@stonebow.otago.ac.nz. mzach@xtra.co.nz.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 8 OCT 2008

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This is not the most recent version of the article. View current version (11 SEP 2013)

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

A number of methods have been used to try to protect kidney function in patients undergoing surgery. These include the administration of dopamine and its analogues, diuretics, calcium channel blockers, angiotensin converting enzyme inhibitors and hydration fluids.

Objectives

For this review, we selected randomized controlled trials which employed different methods to protect renal function during the perioperative period. In examining these trials, we looked at outcomes that included renal failure and mortality as well as changes in renal function tests, such as urine output, creatinine clearance, free water clearance, fractional excretion of sodium and renal plasma flow.

Search methods

We searched the Cochrane Central register of Controlled Trials (CENTRAL) (The Cochrane Library 2007, Issue 2), MEDLINE (1966 to June, 2007), and EMBASE (1988 to June, 2007); and handsearched six journals (Anesthesia and Analgesia, Anesthesiology, Annals of Surgery, British Journal of Anaesthesia, Journal of Thoracic and Cardiovascular Surgery, and Journal of Vascular Surgery).

Selection criteria

We selected all randomized controlled trials in adults undergoing surgery where a treatment measure was used for the purpose of renal protection in the perioperative period.

Data collection and analysis

We selected 53 studies for inclusion in this review. As well as data analysis from all the studies, we performed subgroup analysis for type of intervention, type of surgical procedure, and pre-existing renal dysfunction. We undertook sensitivity analysis on studies with high and moderately good methodological quality.

Main results

The review included data from 53 studies, comprising a total of 2327 participants. Of these, 1293 received some form of treatment and 1034 acted as controls. The interventions mostly consisted of different pharmaceutical agents, such as dopamine and its analogues, diuretics, calcium channel blockers, ACE inhibitors, or selected hydration fluids. The results indicated that certain interventions showed minimal benefits. All the results suffered from significant heterogeneity. Hence we cannot draw conclusions about the effectiveness of these interventions in protecting patients' kidneys during surgery.

Authors' conclusions

There is no reliable evidence from the available literature to suggest that interventions during surgery can protect the kidneys from damage. There is a need for more studies with high methodological quality. One particular area for further study may be patients with pre-existing renal dysfunction undergoing surgery.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

There is no evidence that any of the measures used to protect patients' kidneys during the perioperative period are beneficial

There is no evidence from available randomized controlled trials to suggest that any of the measures used to protect the kidneys during the perioperative period, including the use of dopamine and its analogues, diuretics, calcium channel blockers, ACE inhibitors or hydration fluids, are beneficial. There is no difference in morbidity (renal failure) or mortality following the various perioperative interventions. There is a need for well-designed randomized controlled trials in this field, particularly in patients with pre-existing renal dysfunction.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

在手術期間保護病患腎功能的治療方式

過去曾使用很多方法保護接受手術的病人的腎功能。這些方式包括使用dopamine與其類似藥物, 利尿劑(diuretics), 鈣離子拮抗劑(calcium channel blockers), 血管張力素轉換脢抑制劑(angiotensin converting enzyme inhibitors)及輸液治療。

目標

此篇回顧性文章挑選了使用各種不同方法保護術中病患腎功能的隨機分配研究。我們檢視這些研究的最終結果包括腎衰竭(renal failure)、死亡率,以及腎功能相關實驗數據的變化, 如尿量、肌酐酸清除率(creatinine clearance)、水分清除(free water clearance)、鈉離子清除分率(fractional excretion of sodium)及腎臟血流量(renal plasma flow)。

搜尋策略

搜尋the Cochrane Central register of Controlled Trials (CENTRAL) (The Cochrane Library 2007, Issue 2), MEDLINE (1966to June, 2007), 及EMBASE (1988 to June,2007); 和手動檢索6份雜誌(Anesthesia and Analgesia, Anesthesiology, Annals of Surgery, British Journal of Anaesthesia, Journal of Thoracicand Cardiovascular Surgery, and Journal of Vascular Surgery)。

選擇標準

我們挑選成人在手術期間接受保護腎功能的治療的隨機分配研究。

資料收集與分析

此次回顧挑出53個符合條件的研究分析。分析所有資料的同時, 我們也進行子群體在不同治療方式、手術術式及本來就具有腎功能異常病患的各項分析。我們用高度到中等程度的方法品質要求進行各研究的敏感度的分析。

主要結論

此篇回顧收集了53篇研究, 比較了總共2327個病人。其中1293名病患接受了各種不同形式的治療,另外1034名病患為對照組。治療方法為使用不同的藥物,如dopamine及其類似藥物及其類似藥物、利尿劑, 鈣離子拮抗劑,血管張力素轉換脢抑制劑及輸液治療。結果指出某些治療顯示些微極少助益。但所有的結果因為明顯的異質性而無法形成共識。因此我們不能獲得這些治療能有效保護接受手術的病患之腎功能的結論。

作者結論

過去文獻中沒有可靠的證據建議手術中使用任何治療可保護腎臟功能不被破壞。所以仍需要使用高竿的方法學來進一步研究,尤其是已存在腎功能異常的病人接受手術時如何保護腎臟功能。

翻譯人

本摘要由慈濟醫院鄭偉君翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

手術中有很多治療方法被用來保護腎臟功能。此篇回顧文章探討這些方法的有效性。尚未有研究提供證據建議以下的治療方法對保護手術中病人的腎功能是有益的, 包括dopamine 利尿劑, 鈣離子拮抗劑,血管張力素轉換脢抑制劑或輸液治療。不管手術期間有無接受各項治療, 對產生併發症(腎衰竭)或死亡率是沒有差異的。針對此領域,尤其是已存在腎功能異常的病患來說,仍需要一個設計完整的隨機分配研究來提供有力證據。