Document Detail


Off-pump coronary artery bypass surgery and acute kidney injury: a meta-analysis of randomized controlled trials.
MedLine Citation:
PMID:  20671222     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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 [CI] 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.
Authors:
Victor F Seabra; Sami Alobaidi; Ethan M Balk; Alan H Poon; Bertrand L Jaber
Publication Detail:
Type:  Journal Article; Meta-Analysis; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2010-07-29
Journal Detail:
Title:  Clinical journal of the American Society of Nephrology : CJASN     Volume:  5     ISSN:  1555-905X     ISO Abbreviation:  Clin J Am Soc Nephrol     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-10-08     Completed Date:  2011-01-21     Revised Date:  2013-05-29    
Medline Journal Info:
Nlm Unique ID:  101271570     Medline TA:  Clin J Am Soc Nephrol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1734-44     Citation Subset:  IM    
Affiliation:
Department of Medicine, Division of Nephrology, Kidney and Dialysis Research Laboratory, St. Elizabeth's Medical Center, Boston, Massachusetts 02135, USA.
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MeSH Terms
Descriptor/Qualifier:
Acute Kidney Injury / etiology*,  mortality,  therapy
Aged
Coronary Artery Bypass / adverse effects*,  mortality
Coronary Artery Bypass, Off-Pump / adverse effects*,  mortality
Evidence-Based Medicine
Female
Humans
Incidence
Male
Middle Aged
Odds Ratio
Randomized Controlled Trials as Topic
Renal Dialysis
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
Grant Support
ID/Acronym/Agency:
DK077751/DK/NIDDK NIH HHS
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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