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Meta-Analysis
. 2013 Sep 11;2013(9):CD003590.
doi: 10.1002/14651858.CD003590.pub4.

Interventions for protecting renal function in the perioperative period

Mathew Zacharias  1 , Mohan Mugawar, G Peter Herbison, Robert J Walker, Karen Hovhannisyan, Pal Sivalingam, Niamh P Conlon
Affiliations
Meta-Analysis

Interventions for protecting renal function in the perioperative period

Mathew Zacharias et al. Cochrane Database Syst Rev. .

Abstract

Background: Various methods have been used to try to protect kidney function in patients undergoing surgery. These most often include pharmacological interventions such as dopamine and its analogues, diuretics, calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors, N-acetyl cysteine (NAC), atrial natriuretic peptide (ANP), sodium bicarbonate, antioxidants and erythropoietin (EPO).

Objectives: This review is aimed at determining the effectiveness of various measures advocated to protect patients' kidneys during the perioperative period.We considered the following questions: (1) Are any specific measures known to protect kidney function during the perioperative period? (2) Of measures used to protect the kidneys during the perioperative period, does any one method appear to be more effective than the others? (3) Of measures used to protect the kidneys during the perioperative period,does any one method appear to be safer than the others?

Search methods: In this updated review, we searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 2, 2012), MEDLINE (Ovid SP) (1966 to August 2012) and EMBASE (Ovid SP) (1988 to August 2012). We originally 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) (1985 to 2004). However, because these journals are properly indexed in MEDLINE, we decided to rely on electronic searches only without handsearching the journals from 2004 onwards.

Selection criteria: We selected all randomized controlled trials in adults undergoing surgery for which a treatment measure was used for the purpose of providing renal protection during the perioperative period.

Data collection and analysis: We selected 72 studies for inclusion in this review. Two review authors extracted data from all selected studies and entered them into RevMan 5.1; then the data were appropriately analysed. We performed subgroup analyses for type of intervention, type of surgical procedure and pre-existing renal dysfunction. We undertook sensitivity analyses for studies with high and moderately good methodological quality.

Main results: The updated review included data from 72 studies, comprising a total of 4378 participants. Of these, 2291 received some form of treatment and 2087 acted as controls. The interventions consisted most often of different pharmaceutical agents, such as dopamine and its analogues, diuretics, calcium channel blockers, ACE inhibitors, NAC, ANP, sodium bicarbonate, antioxidants and EPO or selected hydration fluids. Some clinical heterogeneity and varying risk of bias were noted amongst the studies, although we were able to meaningfully interpret the data. Results showed significant heterogeneity and indicated that most interventions provided no benefit.Data on perioperative mortality were reported in 41 studies and data on acute renal injury in 44 studies (all interventions combined). Because of considerable clinical heterogeneity (different clinical scenarios, as well as considerable methodological variability amongst the studies), we did not perform a meta-analysis on the combined data.Subgroup analysis of major interventions and surgical procedures showed no significant influence of interventions on reported mortality and acute renal injury. For the subgroup of participants who had pre-existing renal damage, the risk of mortality from 10 trials (959 participants) was estimated as odds ratio (OR) 0.76, 95% confidence interval (CI) 0.38 to 1.52; the risk of acute renal injury (as reported in the trials) was estimated from 11 trials (979 participants) as OR 0.43, 95% CI 0.23 to 0.80. Subgroup analysis of studies that were rated as having low risk of bias revealed that 19 studies reported mortality numbers (1604 participants); OR was 1.01, 95% CI 0.54 to 1.90. Fifteen studies reported data on acute renal injury (criteria chosen by the individual studies; 1600 participants); OR was 1.03, 95% CI 0.54 to 1.97.

Authors' conclusions: No reliable evidence from the available literature suggests that interventions during surgery can protect the kidneys from damage. However, the criteria used to diagnose acute renal damage varied in many of the older studies selected for inclusion in this review, many of which suffered from poor methodological quality such as insufficient participant numbers and poor definitions of end points such as acute renal failure and acute renal injury. Recent methods of detecting renal damage such as the use of specific biomarkers and better defined criteria for identifying renal damage (RIFLE (risk, injury, failure, loss of kidney function and end-stage renal failure) or AKI (acute kidney injury)) may have to be explored further to determine any possible benefit derived from interventions used to protect the kidneys during the perioperative period.

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Conflict of interest statement

Mathew Zacharias: none known

Mohan Mugawar: none known

G Peter Herbison: none known

Robert J Walker: none known

Karen Hovhannisyan: none known

Palvannan Sivalingam: none known

Niamh P Conlon: none known

Figures

1
1
Study flow diagram, as of December 2012.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across 78 included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
4
4
Funnel plot of comparison: 12 Studies on participants with pre‐existing renal impairment, outcome: 12.1 Mortality.
5
5
Funnel plot of comparison: 12 Studies on participants with pre‐existing renal impairment, outcome: 12.2 Acute renal injury.
6
6
Funnel plot of comparison: 13 Studies with low risk of bias: sensitivity analysis, outcome: 13.1 Reported mortality, low risk of bias studies only.
7
7
Funnel plot of comparison: 13 Studies with low risk of bias: sensitivity analysis, outcome: 13.2 Acute renal injury, requiring dialysis, low risk of bias studies only.
1.1
1.1. Analysis
Comparison 1 Dopamine and analogues versus no intervention, Outcome 1 Mortality.
1.2
1.2. Analysis
Comparison 1 Dopamine and analogues versus no intervention, Outcome 2 Acute renal injury.
1.3
1.3. Analysis
Comparison 1 Dopamine and analogues versus no intervention, Outcome 3 Urine output.
1.4
1.4. Analysis
Comparison 1 Dopamine and analogues versus no intervention, Outcome 4 Creatinine clearance.
1.5
1.5. Analysis
Comparison 1 Dopamine and analogues versus no intervention, Outcome 5 Free water clearance.
1.6
1.6. Analysis
Comparison 1 Dopamine and analogues versus no intervention, Outcome 6 Fractional excretion of sodium.
1.7
1.7. Analysis
Comparison 1 Dopamine and analogues versus no intervention, Outcome 7 Renal plasma flow (24 hours).
2.1
2.1. Analysis
Comparison 2 Diuretics versus no intervention, Outcome 1 Mortality.
2.2
2.2. Analysis
Comparison 2 Diuretics versus no intervention, Outcome 2 Acute renal injury.
2.3
2.3. Analysis
Comparison 2 Diuretics versus no intervention, Outcome 3 Urine output.
2.4
2.4. Analysis
Comparison 2 Diuretics versus no intervention, Outcome 4 Creatinine clearance.
3.1
3.1. Analysis
Comparison 3 Calcium channel blockers versus no intervention, Outcome 1 Mortality.
3.2
3.2. Analysis
Comparison 3 Calcium channel blockers versus no intervention, Outcome 2 Acute renal injury.
3.3
3.3. Analysis
Comparison 3 Calcium channel blockers versus no intervention, Outcome 3 Urine output.
3.4
3.4. Analysis
Comparison 3 Calcium channel blockers versus no intervention, Outcome 4 Creatinine clearance.
3.5
3.5. Analysis
Comparison 3 Calcium channel blockers versus no intervention, Outcome 5 Free water clearance.
4.1
4.1. Analysis
Comparison 4 ACE inhibitors versus no intervention, Outcome 1 Mortality.
4.2
4.2. Analysis
Comparison 4 ACE inhibitors versus no intervention, Outcome 2 Acute renal injury.
4.3
4.3. Analysis
Comparison 4 ACE inhibitors versus no intervention, Outcome 3 Renal plasma flow.
5.1
5.1. Analysis
Comparison 5 Atrial natriuretic peptide versus no intervention, Outcome 1 Mortality.
5.2
5.2. Analysis
Comparison 5 Atrial natriuretic peptide versus no intervention, Outcome 2 Acute renal injury.
5.3
5.3. Analysis
Comparison 5 Atrial natriuretic peptide versus no intervention, Outcome 3 Urine output at 24 hours.
5.4
5.4. Analysis
Comparison 5 Atrial natriuretic peptide versus no intervention, Outcome 4 Creatinine clearance, 24 hours.
5.5
5.5. Analysis
Comparison 5 Atrial natriuretic peptide versus no intervention, Outcome 5 Creatinine clearance, 2 to 3 days.
6.1
6.1. Analysis
Comparison 6 N‐Acetyl cysteine versus no intervention, Outcome 1 Mortality.
6.2
6.2. Analysis
Comparison 6 N‐Acetyl cysteine versus no intervention, Outcome 2 Acute renal injury.
6.3
6.3. Analysis
Comparison 6 N‐Acetyl cysteine versus no intervention, Outcome 3 Urine output, 24 hours.
7.1
7.1. Analysis
Comparison 7 Erythropoietin (EPO) versus control, Outcome 1 Mortality.
7.2
7.2. Analysis
Comparison 7 Erythropoietin (EPO) versus control, Outcome 2 Acute renal injury.
7.3
7.3. Analysis
Comparison 7 Erythropoietin (EPO) versus control, Outcome 3 Urine output: 24 hours.
7.4
7.4. Analysis
Comparison 7 Erythropoietin (EPO) versus control, Outcome 4 Urine output: 2 to 3 days.
7.5
7.5. Analysis
Comparison 7 Erythropoietin (EPO) versus control, Outcome 5 Urine output: 5 to 7 days.
8.1
8.1. Analysis
Comparison 8 Intravenous fluid versus control, Outcome 1 Mortality.
8.2
8.2. Analysis
Comparison 8 Intravenous fluid versus control, Outcome 2 Acute renal injury.
8.3
8.3. Analysis
Comparison 8 Intravenous fluid versus control, Outcome 3 Creatinine clearance.
9.1
9.1. Analysis
Comparison 9 Cardiac surgery: subgroup analysis, Outcome 1 Mortality.
9.2
9.2. Analysis
Comparison 9 Cardiac surgery: subgroup analysis, Outcome 2 Acute renal injury.
9.3
9.3. Analysis
Comparison 9 Cardiac surgery: subgroup analysis, Outcome 3 Urine output.
9.4
9.4. Analysis
Comparison 9 Cardiac surgery: subgroup analysis, Outcome 4 Creatinine clearance.
9.5
9.5. Analysis
Comparison 9 Cardiac surgery: subgroup analysis, Outcome 5 Free water clearance.
9.6
9.6. Analysis
Comparison 9 Cardiac surgery: subgroup analysis, Outcome 6 Fractional excretion of sodium.
10.1
10.1. Analysis
Comparison 10 Aortic surgery: subgroup analysis, Outcome 1 Mortality.
10.2
10.2. Analysis
Comparison 10 Aortic surgery: subgroup analysis, Outcome 2 Acute renal injury.
10.3
10.3. Analysis
Comparison 10 Aortic surgery: subgroup analysis, Outcome 3 Urine output.
10.4
10.4. Analysis
Comparison 10 Aortic surgery: subgroup analysis, Outcome 4 Creatinine clearance.
10.5
10.5. Analysis
Comparison 10 Aortic surgery: subgroup analysis, Outcome 5 Free water clearance.
10.6
10.6. Analysis
Comparison 10 Aortic surgery: subgroup analysis, Outcome 6 Fractional excretion of sodium.
10.7
10.7. Analysis
Comparison 10 Aortic surgery: subgroup analysis, Outcome 7 Renal plasma flow.
11.1
11.1. Analysis
Comparison 11 Biliary surgery: subgroup analysis, Outcome 1 Urine output.
11.2
11.2. Analysis
Comparison 11 Biliary surgery: subgroup analysis, Outcome 2 Creatinine clearance.
12.1
12.1. Analysis
Comparison 12 Studies on participants with pre‐existing renal impairment, Outcome 1 Mortality.
12.2
12.2. Analysis
Comparison 12 Studies on participants with pre‐existing renal impairment, Outcome 2 Acute renal injury.
12.3
12.3. Analysis
Comparison 12 Studies on participants with pre‐existing renal impairment, Outcome 3 Urine output.
12.4
12.4. Analysis
Comparison 12 Studies on participants with pre‐existing renal impairment, Outcome 4 Creatinine clearance.
13.1
13.1. Analysis
Comparison 13 Studies with low risk of bias: sensitivity analysis, Outcome 1 Reported mortality, low risk of bias studies only.
13.2
13.2. Analysis
Comparison 13 Studies with low risk of bias: sensitivity analysis, Outcome 2 Acute renal injury, requiring dialysis, low risk of bias studies only.
13.3
13.3. Analysis
Comparison 13 Studies with low risk of bias: sensitivity analysis, Outcome 3 Urine output at 24 hours, low risk of bias studies only.
13.4
13.4. Analysis
Comparison 13 Studies with low risk of bias: sensitivity analysis, Outcome 4 Creatinine clearance at 24 hours, low risk of bias studies only.
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References

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Sezai 2009 {published data only}
    1. Sezai A, Hata M, Niino T, Yoshitake I, Unosawa S, Wakui S, et al. Influence of continuous infusion of low‐dose human atrial natriuretic peptide on renal function during cardiac surgery. Journal of the American College of Cardiology 2009;54(12):1058‐64. [PUBMED: PMID: 19744614] - PubMed
Sezai 2011 {published data only}
    1. Sezai A, Hata M, Niino T, Yoshitake I, Unosawa S, Wakui S, et al. Results of low dose human atrial natriuretic peptide infusion in nondialysis patients with chronic kidney disease undergoing coronary artery bypass grafting. Journal of the American College of Cardiology 2011;58(9):897‐903. [PUBMED: PMID: 21851876] - PubMed
Shackford 1983 {published data only}
    1. Shackford SR, Sise MJ, Friedlund PH, Rowley WR, Peters RM, Virgilio RW, et al. Hypertonic sodium lactate versus lactated Ringer's solution for intravenous fluid therapy in operations on the abdominal aorta. Surgery 1983;94:41‐51. [MEDLINE: ] - PubMed
Shim 2007 {published data only}
    1. Shim JK, Choi SH, Oh YJ, Kim CS, Yoo KJ, Kwak YL. The effect of mannitol on oxygenation and creatinine kinase MB release in patients undergoing multivessel off‐pump coronary artery bypass surgery. The Journal of Thoracic and Cardiovascular Surgery 2007;133(3):704‐9. [MEDLINE: ] - PubMed
Song 2009 {published data only}
    1. Song YR, Lee T, You SJ, Chin HJ, Chae D‐W, Lim C, et al. Prevention of acute kidney injury by erythropoietin in patients undergoing coronary artery bypass grafting: a pilot study. American Journal of Nephrology 2009;30:253‐60. [PUBMED: PMID: 19494484] - PubMed
Tang 1999 {published data only}
    1. Tang AT, El‐Gamel A, Keevil B, Yonan N, Deiraniya AK. The effect of renal dose dopamine on renal tubular function following cardiac surgery: assessed by measuring retinol binding protein (RBP). European Journal of Cardiothoracic Surgery 1999;15:717‐22. [MEDLINE: ] - PubMed
Tang 2002 {published data only}
    1. Tang AT, Knott J, Nanson J, Hsu J, Haw MP, Ohri SK. A prospective randomized study to evaluate the renoprotective action of beating heart coronary surgery in low risk patients. European Journal of Cardiothoracic Surgery 2002;22:118‐23. [MEDLINE: ] - PubMed
Thompson 1986 {published data only}
    1. Thompson JN, Cohen J, Blenkharn JI, McConnell JS, Barr J, Blumgart LH. A randomized clinical trial of oral ursodeoxycholic acid in obstructive jaundice. British Journal of Surgery 1986;73:634‐6. [MEDLINE: ] - PubMed
Turner 2008 {published data only}
    1. Turner S, Derham C, Orsi NM, Bosomworth M, Bellamy MC, Howell SJ. Randomized clinical trial of the effects of methylprednisolone on renal function after major vascular surgery. British Journal of Surgery 2008;95(1):50‐6. [PUBMED: PMID: 18027383] - PubMed
Urzua 1992 {published data only}
    1. Urzua J, Troncoso S, Bugedo G, Canessa R, Munoz H, Lema G, et al. Renal function and cardiopulmonary bypass: effect of perfusion pressure. Journal of Cardiothoracic and Vascular Anesthesia 1992;6(3):299‐303. [MEDLINE: ] - PubMed
Wahbah 2000 {published data only}
    1. Wahbah AM, el‐Hefny MO, Wafa EM, el‐Kharbotly W, el‐Enin AA, Zaglol A, et al. Perioperative renal protection in patients with obstructive jaundice using drug combinations. Hepatogastroenterology 2000;47:1691‐4. [MEDLINE: ] - PubMed
Welch 1995 {published data only}
    1. Welch M, Newstead CG, Smyth JV, Dodd PD, Walker MG. Evaluation of dopexamine hydrochloride as a renoprotective agent during aortic surgery. Annals of Vascular Surgery 1995;9:488‐92. [MEDLINE: ] - PubMed
Wijnen 2002 {published data only}
    1. Wijnen MH, Vader HL, Wall Bake AW, Roumen RM. Can renal dysfunction after infra‐renal aortic aneurysm repair be modified by multi‐antioxidant supplementation?. Journal of Cardiovascular Surgery 2002;43:483‐8. [MEDLINE: ] - PubMed
Witczak 2008 {published data only}
    1. Witczak BJ, Hartmann A, Geiran OR, Bugge JF. Renal function after cardiopulmonary bypass surgery in patients with impaired renal function. A randomized study of the effect of nifedipine. European Journal of Anaesthesiology 2008;25:319‐25. [PUBMED: PMID: 18182121] - PubMed
Woo 2002 {published data only}
    1. Woo EB, Tang AT, el‐Gamel A, Keevil B, Greenhalgh D, Patrick M, et al. Dopamine therapy for patients at risk of renal dysfunction following cardiac surgery: science or fiction?. European Journal of Cardiothoracic Surgery 2002;22:106‐11. [MEDLINE: ] - PubMed
Yavuz 2002A {published data only}
    1. Yavuz S, Ayabaken N, Dilek K, Ozdemir A. Renal dose of dopamine in open heart surgery; does it protect renal tubular function?. Journal of Cardiovascular Surgery 2002;43:25‐30. [MEDLINE: ] - PubMed
Yavuz 2002B {published data only}
    1. Yavuz S, Ayabakan N, Goncu MT, Ozdemir A. Effect of combined dopamine and diltiazem on renal function after cardiac surgery. Medical Science Monitor 2002;8:145‐50. [MEDLINE: ] - PubMed
Zanardo 1993 {published data only}
    1. Zanardo G, Michielon P, Rosi P, Teodori T, Antonucci F, Caenaro G, et al. Effect of a continuous diltiazem infusion on renal function during cardiac surgery. Journal of Cardiothoracic and Vascular Anesthesia 1993;7(6):711‐6. [MEDLINE: ] - PubMed

References to studies excluded from this review

Abe 1993 {published data only}
    1. Abe K, Fujino Y, Sakakibara T. The effect of prostaglandin E1 during cardiopulmonary bypass on renal function after cardiac surgery. European Journal of Clinical Pharmacology 1993;45:217‐20. [MEDLINE: ] - PubMed
Aho 2004 {published data only}
    1. Aho PS, Niemi T, Lindgren L, Lepantalo M. Endovascular vs open AAA repair: similar effects on renal proximal tubular function. Scandinavian Journal of Surgery 2004;93:52‐6. [MEDLINE: ] - PubMed
Amar 2001 {published data only}
    1. Amar D, Fleisher M. Diltiazem treatment does not alter renal function after thoracic surgery. Chest 2001;119(5):1476‐9. [MEDLINE: ] - PubMed
Antonucci 1996 {published data only}
    1. Antonucci F, Calo L, Rizzolo M, Cantaro S, Bertoliswsi M, Travaglini M, et al. Nifedipine can preserve renal function in patients undergoing aortic surgery with infrarenal crossclamping. Nephron 1996;74(4):668‐73. [MEDLINE: ] - PubMed
Baldwin 1994 {published data only}
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Boldt 2000 {published data only}
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Boldt 2006 {published data only}
    1. Boldt J, Scholhorn T, Mayer J, Piper S, Suttner S. The value of albumin‐based intravascular volume replacement strategy in elderly patients undergoing major abdominal surgery. Anesthesia and Analgesia 2006;103(1):191‐9. [MEDLINE: ] - PubMed
Boodhwani 2009 {published data only}
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Boutros 1979 {published data only}
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Bove 2005 {published data only}
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Caglikulekci 1998 {published data only}
    1. Caglikulekciaz S, Yilmaz S, Kayaalp C, Demirbag A, Akoglu M. Postoperative renal function in obstructive jaundice and the effect of dopamine, mannitol and lactulose: a prospective clinical study. The Turkish Journal of Surgery 1998;14(4):230‐6.
Cahill 1987 {published data only}
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Caimmi 2003 {published data only}
    1. Caimmi PP, Pagani L, Micalizzi E, Fiume C, Guani S, Bernardi M, et al. Fenoldopam for renal protection in patients undergoing cardiopulmonary bypass. Journal of Cardiothoracic and Vascular Anesthesia 2003;17(4):491‐4. [MEDLINE: ] - PubMed
Christakis 1992 {published data only}
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Christenson 1995 {published data only}
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Dementi'eva 1996 {published data only}
    1. Dementi'eva II, Charnaia MA, Dzemeshkevich SL, Ziuliaeva TP. The preventive role of large doses of aprotinin in decreasing the degree of metabolic disorders during aortocoronary bypass operations. Anestheziologiia i Reanimatologica (Russian) 1996;1:55‐8. [MEDLINE: ] - PubMed
Feindt 1995 {published data only}
    1. Feindt PR, Walcher S, Volkmer I, Keller HE, Straub U, Hewer H, Seyfert UT, et al. Effect of high‐dose aprotinin on renal function in aortocoronary bypass grafting. Annals of Thoracic Surgery 1995;60:1076‐80. [MEDLINE: ] - PubMed
Fischer 2002 {published data only}
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Fisher 1998 {published data only}
    1. Fisher AR, Jones P, Barlow P, Kennington S, Saville S, Farrimond J, et al. The influence of mannitol on renal function during and after open‐heart surgery. Perfusion 1998;13:181‐6. [MEDLINE: ] - PubMed
Franklin 1997 {published data only}
    1. Franklin SC, Moulton M, Sicard GA, Hammerman MR, Miller SB. Insulin‐like growth factor I preserves renal function postoperatively. American Journal of Physiology: Renal, Fluid and Electrolyte Physiology 1997;272(241‐2):F257‐9. [MEDLINE: ] - PubMed
Frumento 2006 {published data only}
    1. Frumento RJ, Logginidou HG, Wahlqander S, Wagener G, Playford HR, Sladen RN. Dexmedetomidine infusion is associated with enhanced renal function after thoracic surgery. Journal of Clinical Anesthesia 2006;18:422‐6. [MEDLINE: ] - PubMed
Garwood 2003 {published data only}
    1. Garwood S, Swamidoss CP, Davis EA, Samson L, Hines RL. A case series of low dose fenoldopam in seventy cardiac surgical patients at increased risk of renal dysfunction. Journal of Cardiothoracic and Vascular Anesthesia 2003;17(1):17‐21. [MEDLINE: ] - PubMed
Gatot 2004 {published data only}
    1. Gatot I, Abramov D, Tsodikov V, Yeshaaiahu M, Orman S, Gavriel A, et al. Should we give prophylactic "renal‐dose" dopamine after coronary artery bypass surgery?. Journal of Cardiac Surgery 2004;19:128‐33. [MEDLINE: ] - PubMed
Gerola 2004 {published data only}
    1. Gerola LR, Buffolo E, Jasbik W, Botelho B, Bosco J, Brasil LA, et al. Off‐pump versus on‐pump myocardial revascularization in low‐risk patients with one or two vessel disease: perioperative results in a multicenter randomized controlled trial. Annals of Thoracic Surgery 2004;77:569‐73. [MEDLINE: ] - PubMed
Gilbert 2001 {published data only}
    1. Gilbert TB, Hasnain JU, Flinn WR, Benjamin ME. Fenoldopam infusion associated with preserving renal function after aortic cross‐clamping for aneurysm repair. Journal of Cardiovascular Pharmacology and Therapeutics 2001;6:31‐6. [MEDLINE: ] - PubMed
Godet 2008 {published data only}
    1. Godet G, Lehot J‐J, Janvier G, Steib A, Castro V, Coriat P. Safety of HES 130/0.4 (Voluven) in patients with preoperative renal dysfunction undergoing abdominal aortic surgery: a prospective randomized controlled parallel‐group multicentre trial. European Journal of Anaesthesiology 2008;25:986‐94. [PUBMED: PMID: 18492315] - PubMed
Goto 1992 {published data only}
    1. Goto F, Kato S, Sudo I. Treatment of intraoperative hypertension with enflurane, nicardipine, or human atrial natriuretic peptide: haemodynamic and renal effects. Canadian Journal of Anaesthesia 1992;39(9):932‐7. [MEDLINE: ] - PubMed
Grundmann 1985 {published data only}
    1. Grundmann R, Heistermann S. Postoperative albumin infusion therapy based on colloid osmotic pressure. Archives of Surgery 1985;120:911‐5. [MEDLINE: ] - PubMed
Halpenny 2001 {published data only}
    1. Halpenny M, Lakshmi S, O'Donnell A, O'Callaghan‐Enright, Shorten GD. Fenoldopam: renal and splanchnic effects in patients undergoing coronary artery bypass grafting. Anaesthesia 2001;56:953‐60. [MEDLINE: ] - PubMed
Hayashida 1997 {published data only}
    1. Hayashida M, Hanaoka K, Shimada Y, Namiki A, Amaha K. The effect of low‐dose prostglandin E1 on intra‐ and post‐operative renal function. The Japanese Journal of Anesthesiology 1997;46(4):464‐70. [MEDLINE: ] - PubMed
Hayashida 2000 {published data only}
    1. Hayashida N, Chihara S, Kashikie H, Tayama E, Yokose S, Akasu K, et al. Effects of intraoperative administration of atrial natriuretic peptide. Annals of Annals of Thoracic Surgery 2000;70:1319‐26. [MEDLINE: ] - PubMed
Hisatomi 2012 {published data only}
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Izumi 2006 {published data only}
    1. Izumi Y, Magishi K, Ishikawa N, Kimura F. On‐pump beating‐heart coronary artery bypass grafting for acute myocardial infarction. Annals of Thoracic Surgery 2006;81:573‐6. [MEDLINE: ] - PubMed
Izumi 2008 {published data only}
    1. Izumi K, Eishi K, Yamachika S, Hashizume K, Miura T, Nakaji S. The efficacy of human atrial natriuretic peptide in patients with renal dysfunction undergoing cardiac surgery. Annals of Thoracic and Cardiovascular Surgery 2008;14(5):294‐302. [PUBMED: PMID: 18989245 ] - PubMed
Junnarkar 2003 {published data only}
    1. Junnerkar S, Lau LL, Edrees WK, Underwood D, Smye MG, Lee B, et al. Cytokine activation and intestinal mucosal and renal dysfunction are reduced in endovascular AAA repair compared to surgery. Journal of Endovascular Therapy 2003;10:195‐202. [MEDLINE: ] - PubMed
Kulka 1993 {published data only}
    1. Kulka PJ, Tryba M, Menzel C, Leurs F, Frankenberg C. Preoperative clonidine improves postoperative renal function in CABG patients. British Journal of Anaesthesia 1993;70:74.
Kumle 1999 {published data only}
    1. Kumle B, Boldt J, Piper S, Schmidt C, Suttner S, Salopek S. The influence of different intravascular volume replacement regimens on renal function in the elderly. Anesthesia and Analgesia 1999;89:1124‐30. [MEDLINE: ] - PubMed
Kunt 2009 {published data only}
    1. Kunt AT, Akgun S, Atalan N, Bitir N, Arsan S. Frusamide infusion prevents the requirement of renal replacement therapy after cardiac surgery. The Anatolian Journal of Cardiology 2009;9(6):499‐504. [PUBMED: PMID: 19965324 ] - PubMed
Kuraoka 1995 {published data only}
    1. Kuraoka S, Orita H, Watanabe T, Abe K, Abe H, Inui S, et al. Effect of combined aprotinin and prostaglandin E1 therapy on aortic arch replacement. The Japanese Journal of Thoracic Surgery 1995;48(3):198‐201. [MEDLINE: ] - PubMed
Lema 1995 {published data only}
    1. Lema G, Meneses G, Urzua J, Jalil R, Canessa R, Moran S, et al. Effects of extracorporeal circulation on renal function in coronary surgical patients. Anesthesia and Analgesia 1995;81:446‐51. [MEDLINE: ] - PubMed
Lema 1998 {published data only}
    1. Lema G, Urzua J, Jalil R, Canessa R, Moran S, Sacco C, et al. Renal protection in patients undergoing cardiopulmonary bypass with preoperative abnormal renal function. Anesthesia and Analgesia 1998;86(1):3‐8. [MEDLINE: ] - PubMed
Lemmer 1996 {published data only}
    1. Lemmer JH Jr, Dilling EW, Morton JR, Rich JB, Robicsek F, Bricker DL, et al. Aprotinin for primary coronary artery bypass grafting: a multicenter trial of three dose regimens. Annals of Thoracic Surgery 1996;62:1659‐68. [MEDLINE: ] - PubMed
Levy 1995 {published data only}
    1. Levy JH, Pifarre R, Schaff HV, Horrow JC, Albus R, Spiess B, et al. A multicenter, double‐blind, placebo‐controlled trial of aprotinin for reducing blood loss and the requirement for donor‐blood transfusion in patients undergoing repeat coronary artery bypass grafting. Circulation 1995;92(8):2236‐44. [MEDLINE: ] - PubMed
Licker 1999 {published data only}
    1. Licker M, Schweizer A, Hohn L, Morel DR. Chronic angiotensin converting inhibition does not influence renal hemodynamic and function during cardiac surgery. Canadian Journal of Anaesthesia 1999;46(7):626‐34. [MEDLINE: ] - PubMed
Lim 2002 {published data only}
    1. Lim E, Ali ZA, Attaran R, Cooper G. Evaluating routine diuretics after coronary surgery: a prospective randomized controlled study. Annals of Thoracic Surgery 2002;73:153‐5. [MEDLINE: ] - PubMed
Loef 2002 {published data only}
    1. Loef BG, Epema AH, Navis G, Ebels T, Oeveren W, Henning RH. Off‐pump coronary revascularization attenuates transient renal damage compared with on‐pump coronary revascularization. Chest 2002;121(4):1190‐4. [MEDLINE: ] - PubMed
MacGregor 1994 {published data only}
    1. MacGregor DA, Butterworth JF 4th, Zaloga CP, Prielipp RC, James R, Royster RL. Hemodynamic and renal effects of dopexamine and dobutamine in patients with reduced cardiac output following coronary artery bypass grafting. Chest 1994;106:835‐41. [MEDLINE: ] - PubMed
Mahesh 2008 {published data only}
    1. Mahesh B, Yim B, Robson D, Pillai R, Ratnatunga C, Pigott D. Does furosemide prevent renal dysfunction in high‐risk cardiac surgical patients? Results of a double‐blinded prospective randomised trial. European Journal of Cardiothoracic Surgery 2008;33:370‐6. [PUBMED: PMID: 18243724] - PubMed
Mahmood 2007 {published data only}
    1. Mahmood A, Gosling P, Vohra RK. Randomized clinical trial comparing the effects on renal function of hydroxyethyl starch or gelatine during aortic aneurysm surgery. British Journal of Surgery 2007;94:427‐33. [PUBMED: PMID: 17380548] - PubMed
Memmo 2011 {published data only}
    1. Memmo A, Carozzo A, Landoni G, Fano G, Sottocorna O, Bignami E, et al. Perioperative fenoldopam for the prevention of acute renal failure in non‐cardiac surgery, randomized clinical trial. Signa Vitae 2011;6(1):14‐9.
Neimark 2005 {published data only}
    1. Neimark MI, Merkulov IV, Flat MK. Renal protective function in surgical treatment for chronic infrarenal aortic aneurysms. Anesteziologiia i Reanimatologiia 2005;4:18‐22. [MEDLINE: ] - PubMed
Nguyen 2001 {published data only}
    1. Nguyen NT, Lee SL, Anderson JT, Palmer LS, Canet F, Wolfe BM. Evaluation of intra‐abdominal pressure after laparoscopic and open gastric bypass. Obesity Surgery 2001;11:40‐5. [MEDLINE: ] - PubMed
Nguyen 2002 {published data only}
    1. Nguyen NT, Perez RV, Fleming N, Rivers R, Wolfe BM. Effect of prolonged pneumoperitoneum on intraoperative urine output during laparoscopic gastric bypass. Journal of American College of Surgeons 2002;195:476‐83. [MEDLINE: ] - PubMed
Niiya 2001 {published data only}
    1. Niiya S, Fukusaki M, Nakamura T, Miyoshi H, Ogata K, Miyako M. Effects of dopamine and dobutamine on renal function and urinary excretion of prostaglandin E2 in elderly postoperative patients [In Japanese]. Japanese Journal of Anesthesiology 2001;50:122‐6. [MEDLINE: ] - PubMed
Nuutinen 1976 {published data only}
    1. Nuutinen L, Hollmen A. The effect of prophylactic use of furosemide on renal function during open heart surgery. Annales Chirurgiae et Gynaecologiae 1976;65:258‐66. [MEDLINE: ] - PubMed
O'Hara 2002A {published data only}
    1. O'Hara JF, Sprung J. The effect of dopamine on renal function in solitary partial nephrectomy patients. Anesthesia and Analgesia 2002;94(Suppl):104.
Oliver 2006 {published data only}
    1. Oliver WC, Nuttall GA, Cherry KJ, Decker PA, Bower T, Ereth MH. A comparison of fenoldopam with dopamine and sodium nitroprusside in patients undergoing cross‐clamping of the abdominal aorta. Anesthesia and Analgesia 2006;103(4):833‐40. [MEDLINE: ] - PubMed
Ovrum 2004 {published data only}
    1. Ovrum E, Tangen G, Tollofsrud S, Oystese R, Ringdal MAL, Istad R. Cold blood cardioplegia versus cold crystalloid cardioplegia: a prospective randomized study of 1440 patients undergoing coronary artery bypass grafting. The Journal of Thoracic and Cardiovascular Surgery 2004;128(6):860‐5. [MEDLINE: ] - PubMed
Pain 1991 {published data only}
    1. Pain JA, Cahill CJ, Gilbert JM, Johnson CD, Trapnell JE, Bailey ME. Prevention of postoperative renal dysfunction in patients with obstructive jaundice: a multi‐centre study of bile salts and lactulose. British Journal of Surgery 1991;78:467‐9. [MEDLINE: ] - PubMed
Paul 1986 {published data only}
    1. Paul MD, Mazer CD, Byrick RJ, Rose DK, Goldstein MB. Influence of mannitol and dopamine on renal function during elective infrarenal aortic clamping in man. American Journal of Nephrology 1986;6:427‐34. [MEDLINE: ] - PubMed
Pavoni 1998 {published data only}
    1. Pavoni V, Verri M, Ferraro L, Volta CA, Paparella L, Capuzzo M, et al. Plasma dopamine concentration and effects of low dopamine doses on urinary output after major vascular surgery. Kidney International 1998;53(Suppl 66):S75‐80. [MEDLINE: ] - PubMed
Petry 1992 {published data only (unpublished sought but not used)}
    1. Petry A, Wulf H, Blomer U, Wawersik J. Nifedipine versus nitroglycerin in aortocoronary bypass surgery [Nifedipin versus nitrat bei aorto‐koronaren bypassoperationen [German]]. Anaesthesist 1992;41:39‐46. [1536439] - PubMed
Piper 2003 {published data only}
    1. Piper SN, Kumle B, Maleck WH, Kiessling AH, Lehmann A, Rohm KD. Diltiazem may preserve renal tubular integrity after cardiac surgery. Canadian Journal of Anaesthesia 2003;50(3):285‐92. [MEDLINE: ] - PubMed
Plusa 1991 {published data only}
    1. Plusa SM, Clark NW. Prevention of postoperative renal dysfunction in patients with obstructive jaundice: a comparison of mannitol‐induced diuresis and oral sodium taurocholate. Journal of the Royal College of Surgeons of Edinburgh 1991;36:303‐5. [MEDLINE: ] - PubMed
Priano 1993 {published data only}
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Prifti 2001 {published data only}
    1. Prifti E, Boinacchi M, Frati G, Giunti G, Proietti P, Leacche M, et al. Beating heart myocardial revascularization on extracorporeal circulation in patients with end‐stage coronary artery disease. Cardiovascular Surgery 2001;9(6):608‐13. [MEDLINE: ] - PubMed
Regragui 1995 {published data only}
    1. Regragui IA, Izzat MB, Birdi I, Lapsley M, Bryan AJ, Angelini GD. Cardiopulmonary bypass perfusion temperature does not influence perioperative renal function. Annals of Thoracic Surgery 1995;60:160‐4. [MEDLINE: ] - PubMed
Riess 2000 {published data only}
    1. Riess FC, Moshar S, Bader R, Schofer J, Lower C, Kremer P, et al. Clinical outcome of patients with and without renal impairment undergoing a minimally invasive LIMA‐to‐LAD bypass operation. Heart Surgery Forum 2000;3(4):313‐8. [MEDLINE: ] - PubMed
Ryckwaert 1995 {published data only}
    1. Ryckwaert F, Calvert B, Peckstaing M, Wintrebert P, Ribstein J, Colson P. Effects of enalaprilate on haemodynamics and renal function during cardiac surgery in patients with preoperative heart failure. British Journal of Anaesthesia 1995;74:A103.
Sanders 2001 {published data only}
    1. Sanders G, Mercer SJ, Saeb‐Parsey K, Akhavani MA, Hosie KB, Lambert AW. Randomized clinical trial of intravenous fluid replacement during bowel preparation for surgery. British Journal of Surgery 2001;88:1363‐5. [MEDLINE: ] - PubMed
Sezai 2006 {published data only}
    1. Sezai A, Shiono M, Hata M, Iida M, Wakui S, Soeda M, et al. Efficacy of continuous low‐dose human atrial natriuretic peptide given from the beginning of cardiopulmonary bypass for thoracic aortic surgery. Surgery Today 2006;36:508‐14. [MEDLINE: ] - PubMed
Sherry 1997 {published data only}
    1. Sherry E, Tooley MA, Bolsin SN, Monk CR, Wilcox J. Effect of dopexamine hydrochloride on renal vascular resistance index and haemodynamic responses following coronary artery bypass graft surgery. European Journal of Anaesthesiology 1997;14:184‐9. [MEDLINE: ] - PubMed
Skillman 1975 {published data only}
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Stanitsh 2002 {published data only}
    1. Stanitsh MB, Sindjelitsh RB, Neshkovitsh V, Davidovitsh LB, Lotina SL. Renal protection during the operation of infra‐renal aorta [In Serbian]. Srpski Archv Za Celokupno Lekarstvo (Serbian) 2002;130(5‐6):168‐72.
Straka 2004 {published data only}
    1. Straka Z, Widimsky P, Jirasek K, Stros P, Votava J, Vanek T, et al. Off‐pump versus on‐pump coronary surgery: final results from a prospective randomized study PRAGUE‐4. Annals of Thoracic Surgery 2004;77:789‐93. [MEDLINE: ] - PubMed
Tataranni 1994 {published data only}
    1. Tataranni G, Malacarne F, Farinelli R, Tarroni G, Gritti G, Guberti A, et al. Beneficial effects of verapamil in renal‐risk surgical patients. Renal Failure 1994;16(3):383‐90. [MEDLINE: ] - PubMed
Torsello 1993 {published data only}
    1. Torsello G, Kutkuhn B, Kniemeyer H, Sandmann W. Prevention of acute renal failure after suprarenal aortic surgery: results of a pilot study. Zentralblatt fur Chirurgie 1993;118:390‐4. [MEDLINE: ] - PubMed
Tripathy 1996 {published data only}
    1. Tripathy U, Dhiman RK, Attari A, Katariya RN, Ganguly NK, Chawla YK, et al. Preoperative bile salt administration versus bile salt refeeding in obstructive jaundice. The National Medical Journal of India 1996;9(2):66‐9. [MEDLINE: ] - PubMed
Ueki 1995 {published data only}
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Vogt 1996 {published data only}
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References to studies awaiting assessment

Fergany 2011 {published and unpublished data}
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References to other published versions of this review

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