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Meta-Analysis
. 2015 Jun;65(6):593-600.
doi: 10.1097/FJC.0000000000000229.

Efficacy and Safety of Erythropoietin to Prevent Acute Kidney Injury in Patients With Critical Illness or Perioperative Care: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Chen Zhao  1 , Zhenchuan Lin, Qimei Luo, Xi Xia, Xueqing Yu, Fengxian Huang
Affiliations
Meta-Analysis

Efficacy and Safety of Erythropoietin to Prevent Acute Kidney Injury in Patients With Critical Illness or Perioperative Care: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Chen Zhao et al. J Cardiovasc Pharmacol. 2015 Jun.

Abstract

Objective: The aim was to investigate the efficacy and safety of erythropoietin (EPO) to prevent acute kidney injury (AKI) in patients with critical illness or perioperative care.

Methods: Randomized controlled trials comparing EPO with placebo for AKI prevention in adult patients with critical illness or perioperative care were searched in MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, the Web of Science, and Clinical Trials.gov until October 2014. The outcomes of interest included the incidence of AKI, dialysis requirement, mortality, and adverse event. Fixed effect model was used to calculate the pooled risk ratio (RR) and 95% confidence interval (CI) for eligible studies.

Results: Ten randomized controlled trials involving 2759 participants were identified and included in the analysis. Compared with placebo, EPO administration did not reduce the incidence of AKI (RR, 0.97; 95% CI, 0.79-1.19; P = 0.782), dialysis requirement (RR, 0.72; 95% CI, 0.31-1.70; P = 0.457), or mortality (RR, 0.96; 95% CI, 0.78-1.18; P = 0.705). Moreover, EPO had no effect on the risk of adverse events, but estimations of RR were difficult due to their relatively infrequent occurrence.

Conclusions: This meta-analysis suggests that prophylactic administration of EPO in patients with critical illness or perioperative care does not prevent AKI, dialysis requirement, or mortality.

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Conflict of interest statement

The authors report no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Flow diagram of article selection approach.
FIGURE 2
FIGURE 2
Risk of bias in included studies. A, Risk of bias graph demonstrates the percentages of included studies for each item in the tool; (B) risk of bias summary illustrates the review author's judgments with a cross-tabulation for each eligible study.
FIGURE 3
FIGURE 3
Forest plots of RR estimates with the corresponding 95% CI for (A) the incidence of AKI, (B) dialysis requirement, and (C) mortality in patients receiving EPO therapy versus control. The columns of intervention and control were presented as number of events/number of participants.
FIGURE 4
FIGURE 4
The sensitivity analysis by removing each individual study at a time is shown on the pooled effect size of the incidence of AKI.
FIGURE 5
FIGURE 5
The funnel plots for publication bias tests of studies assessing the effect of EPO on (A) the incidence of AKI and (B) mortality.
See this image and copyright information in PMC

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