Prevention and treatment of acute kidney injury in patients undergoing cardiac surgery: a systematic review

Am J Nephrol. 2010;31(5):408-18. doi: 10.1159/000296277. Epub 2010 Apr 6.


Background: Acute kidney injury (AKI) is common in patients undergoing cardiac surgery and is associated with a high rate of death, long-term sequelae and healthcare costs. We conducted a systematic review of randomized controlled trials for strategies to prevent or treat AKI in cardiac surgery.

Methods: We screened Medline, Scopus, Cochrane Renal Library, and Google Scholar for randomized controlled trails in cardiac surgery for prevention or treatment of AKI in adults.

Results: We identified 70 studies that contained a total of 5,554 participants published until November 2008. Most studies were small in sample size, were single-center, focused on preventive strategies, and displayed wide variation in AKI definitions. Only 26% were assessed to be of high quality according to the Jadad criteria. The types of strategies with possible protective efficacy were dopaminergic agents, vasodilators, anti-inflammatory agents, and pump/perfusion strategies. When analyzed separately, dopamine and N-acetylcysteine did not reduce the risk for AKI.

Conclusions: This summary of all the literature on prevention and treatment strategies for AKI in cardiac surgery highlights the need for better information. The results advocate large, good-quality, multicenter studies to determine whether promising interventions reliably reduce rates of acute renal replacement therapy and mortality in the cardiac surgery setting.

Publication types

  • Research Support, N.I.H., Extramural
  • Review
  • Systematic Review

MeSH terms

  • Acute Kidney Injury / prevention & control*
  • Acute Kidney Injury / therapy*
  • Aged
  • Dopamine Agents / therapeutic use
  • Female
  • Heart Diseases / complications
  • Heart Diseases / surgery
  • Humans
  • Inflammation
  • Kidney / injuries
  • Male
  • Middle Aged
  • Randomized Controlled Trials as Topic
  • Renal Replacement Therapy / methods
  • Risk Factors
  • Thoracic Surgery*
  • Treatment Outcome
  • Vasodilator Agents / therapeutic use


  • Dopamine Agents
  • Vasodilator Agents