Pharmacological strategies for the prevention of acute kidney injury following cardiac surgery: an overview of systematic reviews

Curr Pharm Des. 2014;20(34):5484-8. doi: 10.2174/1381612820666140325113422.


Context: Post cardiac surgery acute kidney injury (AKI) is common, poorly understood and associated with a significant increase in morbidity and mortality.

Objectives: An overview of systematic reviews that have evaluated pharmacological agents for the prevention of AKI post cardiac surgery.

Data sources: We searched electronic databases (PubMed and the Cochrane Database of Systematic Reviews) from inception to January 2014.

Study selection: Systematic reviews of randomized controlled trials that have evaluated pharmacological agents for the prevention of AKI in adult patients undergoing cardiac surgery.

Data analysis: Numbers needed to treat (NNT) or harm (NNH) were calculated from pooled events given in each meta-analysis. Primary outcome measures were defined as (i) mortality, (ii) need for renal replacement therapy (RRT), and (iii) acute kidney injury.

Results: Data from 7 systematic reviews evaluating 6 different pharmacological renoprotective agents were included. Dopamine, fenoldopam and N-acetylcysteine did not demonstrate any benefit in terms of mortality, need for RRT or incidence of AKI. Atrial natriuretic peptide reduced the need for RRT (NNT = 22 (95% CI: 13 to 73) and brain natriuretic peptide reduced the incidence of AKI (NNT = 11 (95% CI: 6 to 32), although both agents did not demonstrate any effect on mortality. Loop diuretics demonstrated increased incidence of AKI (NNH = 8 (95% CI: 5 to 15).

Conclusion: There is a paucity of effective renoprotective agents that can be used in adult cardiac surgical patients. There is an urgent need to develop novel renoprotective strategies.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Acute Kidney Injury / diagnosis
  • Acute Kidney Injury / epidemiology
  • Acute Kidney Injury / prevention & control*
  • Animals
  • Atrial Natriuretic Factor / administration & dosage
  • Cardiac Surgical Procedures / adverse effects*
  • Humans
  • Natriuretic Peptide, Brain / administration & dosage
  • Randomized Controlled Trials as Topic / methods
  • Review Literature as Topic*


  • Natriuretic Peptide, Brain
  • Atrial Natriuretic Factor