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Meta-Analysis
. 2010 Oct;5(10):1734-44.
doi: 10.2215/CJN.02800310. Epub 2010 Jul 29.

Off-pump coronary artery bypass surgery and acute kidney injury: a meta-analysis of randomized controlled trials

Victor F Seabra  1 , Sami Alobaidi, Ethan M Balk, Alan H Poon, Bertrand L Jaber
Affiliations
Meta-Analysis

Off-pump coronary artery bypass surgery and acute kidney injury: a meta-analysis of randomized controlled trials

Victor F Seabra et al. Clin J Am Soc Nephrol. 2010 Oct.

Abstract

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.

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Figures

Figure 1.
Figure 1.
Study selection flow diagram.
Figure 2.
Figure 2.
Forest plot of off-pump versus on-pump CABG on the incidence of AKI. Peto fixed-effect model and DerSimonian & Laird random-effects model (REM) estimate of OR. Dark gray lines correspond to studies with zero events in one arm whereas light gray lines correspond to studies with zero events in both arms. The quality score is based on the Jadad scale, ranging from 0 to 5. *No events in one group: The displayed estimate and CI were calculated by adjusting the numbers of events and nonevents. †Study omitted from meta-analyses because there were no events in both groups: The displayed estimate and CI were calculated by adjusting the numbers of events and nonevents.
Figure 3.
Figure 3.
Forest plot displaying the effect of off-pump versus on-pump CABG on dialysis requirement. Peto fixed-effect model and DerSimonian & Laird random-effects model (REM) estimate of OR. Dark gray lines correspond to studies with zero events in one arm whereas light gray lines correspond to studies with zero events in both arms. The quality score is based on the Jadad scale, ranging from 0 to 5. *No events in one group: The displayed estimate and CI were calculated by adjusting the numbers of events and nonevents. †Study omitted from meta-analyses because there were no events in both groups: The displayed estimate and CI were calculated by adjusting the numbers of events and nonevents.
Figure 4.
Figure 4.
Forest plot displaying the effect of off-pump versus on-pump CABG on mortality. Peto fixed-effect model and DerSimonian & Laird random-effects model (REM) estimate of OR. Dark gray lines correspond to studies with zero events in one arm whereas light gray lines correspond to studies with zero events in both arms. The quality score is based on the Jadad scale, ranging from 0 to 5. *No events in one group: The displayed estimate and CI were calculated by adjusting the numbers of events and nonevents. †Study omitted from meta-analyses because there were no events in both groups: The displayed estimate and CI were calculated by adjusting the numbers of events and nonevents.
Figure 5.
Figure 5.
Subgroup analyses displaying the effect of off-pump versus on-pump CABG on the incidence of AKI, dialysis requirement, and mortality. Peto fixed-effect model estimate of OR. The P value refers to the difference among subgroups using the t test. *Where indicated, the subgroups represent trials with variables of interest that are above or below the median value.
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