Chen X, et al. – Researchers analyzed evidence on comparative efficacies of pharmacologic strategies for the prevention of acute kidney injury (AKI) post– cardiac surgery. Findings reported that in adult patients undergoing cardiac surgery, the preferred prophylactic pharmacologic strategy against AKI, was probably the natriuretic peptide, especially in high–risk patients.

Methods

• Researchers searched PubMed, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL) up to 6 May 2017 and the reference lists of relevant articles about trials.
• The occurrence of AKI was the outcome.
• This is the first network meta-analysis of the different prevention strategies using Bayesian methodology.

Results

• Findings reported that the study included 63 articles with 19,520 participants and assessed the impact of 10 pharmacologic strategies to prevent AKI in patients undergoing cardiac surgery.
• Researchers found that compared with placebo, the odds ratio (OR) for the occurrence of AKI was 0.24 [95% confidence interval (CI) 0.16–0.34] with natriuretic peptide, 0.33 (95% CI 0.14–0.70) with fenoldopam, 0.54 (95% CI 0.31–0.84) with dexmedetomidine, 0.56 (95% CI 0.29–0.95) with low-dose erythropoietin, 0.63 (95% CI 0.43–0.88) with levosimendan, 0.76 (95% CI 0.52–1.10) with steroids, 0.83 (95% CI 0.48–1.40) with high-dose erythropoietin, 0.85 (95% CI 0.64–1.14) with N-acetylcysteine, 0.96 (95% CI 0.69–1.29) with sodium bicarbonate, and 1.05 (95% CI 0.70–1.41) with statins.
• In addition, data showed that the surface under the cumulative ranking curve probabilities indicated that natriuretic peptide was the best treatment therapy and that fenoldopam ranked second.