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Intervenciones para proteger la función renal en el período perioperatorio

Appendices

Appendix 1. Search strategies employed

Search strategy for MEDLINE (Ovid SP)
1 exp Kidney Failure/ or exp Kidney Failure Acute/ or exp Kidney Failure Chronic/ or exp Kidney Function Tests/ or exp Glomerular Filtration Rate/ or exp Renal Circulation/ or exp Renal Plasma Flow/ or exp Renal Insufficiency/ or kidney.ti,ab. or (glomerul* adj3 filtration).mp. or (renal adj3 (failure or protect* or function*)).mp. or kidney function test*.mp. or renal function test*.mp. or free water clearance.mp. or fractional excretion of sodium.mp. or (urine adj3 (output or flow)).mp.
2 exp Angiotensin Converting Enzyme Inhibitors/ or exp Fluid Therapy/ or exp Infusions Intravenous/ or exp Angiotensin Converting Enzyme Inhibitors/ or exp diuretics/ or exp mannitol/ or exp Furosemide/ or exp Dopamine/ or exp Dopamine Agonists/ or (diuretic* or mannitol or frusemide or furosemide).mp. or (fluid* adj3 therap*).mp. or (intravenous adj3 fluid*).mp. or hydration.ti,ab. or angiotensin converting enzyme inhibitor*.mp. or ACE inhibitor*.mp. or dopamin*.ti,ab.
3 exp Perioperative Care/ or exp Intraoperative Period/ or exp Intraoperative Care/ or exp Intraoperative Complications/ or (peri?operativ* or intra?operativ*).ti,ab.
4 1 and 2 and 3
5 reno?protect*.af.
6 4 or 5 (2513)
7 ((randomized controlled trial or controlled clinical trial).pt. or randomized.ab. or placebo.ab. or clinical trials as topic.sh. or randomly.ab. or trial.ti.) not (animals not (humans and animals)).sh.
8 6 and 7

Search strategy for EMBASE (Ovid SP)

1 exp kidney failure/ or exp kidney failure/ or exp kidney function test/ or exp glomerulus filtration rate/ or exp kidney circulation/ or exp kidney clearance/ or exp kidney plasma flow/ or exp urine flow rate/ or exp urine volume/ or kidney.ti,ab. or (glomerul* adj3 filtration).mp. or (renal adj3 (failure or protect* or function*)).mp. or kidney function test*.mp. or renal function test*.mp. or free water clearance.mp. or fractional excretion of sodium.mp. or (urine adj3 (output or flow)).mp.
2 exp dipeptidyl carboxypeptidase inhibitor/ or exp fluid therapy/ or intravenous drug administration/ or exp diuretic agent/ or exp diuretic agent/ or exp mannitol/ or exp furosemide/ or exp dopamine/ or exp dopamine receptor stimulating agent/ or (diuretic* or mannitol or frusemide or furosemide).mp. or (fluid* adj3 therap*).mp. or (intravenous adj3 fluid*).mp. or hydration.ti,ab. or angiotensin converting enzyme inhibitor*.mp. or ACE inhibitor*.mp. or dopamin*.ti,ab.
3 exp perioperative period/ or exp intraoperative period/ or exp peroperative care/ or (peri?operativ* or intra?operativ*).ti,ab.
4 1 and 2 and 3
5 reno?protect*.ti,ab.
6 4 or 5
7 (placebo.sh. or controlled study.ab. or random*.ti,ab. or trial*.ti,ab. or ((singl* or doubl* or trebl* or tripl*) adj3 (blind* or mask*)).ti,ab.) not (animals not (humans and animals)).sh.
8 6 and 7

Search strategy for CENTRAL, The Cochrane Library

#1 MeSH descriptor Acute Kidney Injury explode all trees
#2 MeSH descriptor Kidney Failure, Chronic explode all trees
#3 MeSH descriptor Kidney Function Tests explode all trees
#4 MeSH descriptor Glomerular Filtration Rate explode all trees
#5 MeSH descriptor Renal Circulation explode all trees
#6 MeSH descriptor Renal Plasma Flow, Effective explode all trees
#7 MeSH descriptor Renal Insufficiency explode all trees
#8 kidney
#9 glomerul* near filtration
#10 renal near (failure or protect* or function*)
#11 kidney function test*
#12 renal function test*
#13 free water clearance
#14 (fractional excretion) of sodium
#15 urine near (output or flow)
#16 (#1 OR #2 OR #3 OR #4 OR #5 OR #6 OR #7 OR #8 OR #9 OR #10 OR #11 OR #12 OR #13 OR #14 OR #15)
#17 MeSH descriptor Angiotensin‐Converting Enzyme Inhibitors explode all trees
#18 diuretic* or mannitol or frusemide or furosemide
#19 MeSH descriptor Fluid Therapy explode all trees
#20 fluid* near therap*
#21 MeSH descriptor Infusions, Intravenous explode all trees
#22 (intravenous near fluid*) or hydration
#23 angiotensin converting enzyme inhibitor*
#24 ACE inhibitor*
#25 MeSH descriptor Diuretics explode all trees
#26 MeSH descriptor Mannitol explode all trees
#27 MeSH descriptor Furosemide explode all trees
#28 MeSH descriptor Dopamine explode all trees
#29 MeSH descriptor Dopamine Agonists explode all trees
#30 dopamin*
#31 (#16 OR #17 OR #18 OR #19 OR #20 OR #21 OR #22 OR #23 OR #24 OR #25 OR #26 OR #27 OR #28 OR #29 OR #30)
#32 MeSH descriptor Perioperative Care explode all trees
#33 MeSH descriptor Intraoperative Care explode all trees
#34 MeSH descriptor Intraoperative Complications explode all trees
#35 MeSH descriptor Intraoperative Period explode all trees
#36 perioperativ* or intraoperativ*
#37 (#32 OR #33 OR #34 OR #35 OR #36)
#38 (#16 AND #31 AND #37)

Appendix 2. data extraction form

Data extraction form

Study ID:                                 

Language: English/

What was the surgical procedure? 

What was the study intervention?

How many participants were studied?

How many in the intervention group?

How many in the control group?

Were the inclusion criteria clearly defined?

Were the exclusion criteria clearly defined?

Age group         Intervention                   Control

Male:Female numbers:

Bias:

Was there randomization of allocation in the groups?

Was there adequate information about randomization?

Was there allocation concealment?

Was the allocation concealment adequate?

Were there any withdrawals from the study?

How many people withdrew from each group?

Was there blinding in the study?

Study details:

What was the actual nature of the intervention?

When did the intervention start and finish?

What was the actual nature of the control group?

When did the control group start and finish?

Were the two groups treated equally?

What were the outcomes studied?

Mortality

Acute renal failure

Urine output

Creatinine clearance

Free water clearance

Fractional excretion of sodium

Renal blood flow

Urinary microalbumin:creatinine ratio

Urinary NAG:creatinine ratio

Urinary RBOP:creatinine ratio

Urinary NGAL:creatinine ratio

Plasma cystatin C

When were the outcomes measured?

Preoperative    Postoperative: 24 hours       Postoperative: 48 hours       Postoperative: 72 hours       Postoperative: day (note)

Was the outcome assessment blinded?

Was there intention‐to‐treat analysis?

Are mean and standard deviation given?

Other measures of presentation of data

Graphic data?

Results:

Mean and SD    Other measures: (please specify clearly)

Remarks:

Drug company sponsorship?

Other comments:

Study flow diagram, as of December 2012.
Figuras y tablas -
Figure 1

Study flow diagram, as of December 2012.

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across 78 included studies.
Figuras y tablas -
Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across 78 included studies.

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figuras y tablas -
Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Funnel plot of comparison: 12 Studies on participants with pre‐existing renal impairment, outcome: 12.1 Mortality.
Figuras y tablas -
Figure 4

Funnel plot of comparison: 12 Studies on participants with pre‐existing renal impairment, outcome: 12.1 Mortality.

Funnel plot of comparison: 12 Studies on participants with pre‐existing renal impairment, outcome: 12.2 Acute renal injury.
Figuras y tablas -
Figure 5

Funnel plot of comparison: 12 Studies on participants with pre‐existing renal impairment, outcome: 12.2 Acute renal injury.

Funnel plot of comparison: 13 Studies with low risk of bias: sensitivity analysis, outcome: 13.1 Reported mortality, low risk of bias studies only.
Figuras y tablas -
Figure 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.

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.
Figuras y tablas -
Figure 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.

Comparison 1 Dopamine and analogues versus no intervention, Outcome 1 Mortality.
Figuras y tablas -
Analysis 1.1

Comparison 1 Dopamine and analogues versus no intervention, Outcome 1 Mortality.

Comparison 1 Dopamine and analogues versus no intervention, Outcome 2 Acute renal injury.
Figuras y tablas -
Analysis 1.2

Comparison 1 Dopamine and analogues versus no intervention, Outcome 2 Acute renal injury.

Comparison 1 Dopamine and analogues versus no intervention, Outcome 3 Urine output.
Figuras y tablas -
Analysis 1.3

Comparison 1 Dopamine and analogues versus no intervention, Outcome 3 Urine output.

Comparison 1 Dopamine and analogues versus no intervention, Outcome 4 Creatinine clearance.
Figuras y tablas -
Analysis 1.4

Comparison 1 Dopamine and analogues versus no intervention, Outcome 4 Creatinine clearance.

Comparison 1 Dopamine and analogues versus no intervention, Outcome 5 Free water clearance.
Figuras y tablas -
Analysis 1.5

Comparison 1 Dopamine and analogues versus no intervention, Outcome 5 Free water clearance.

Comparison 1 Dopamine and analogues versus no intervention, Outcome 6 Fractional excretion of sodium.
Figuras y tablas -
Analysis 1.6

Comparison 1 Dopamine and analogues versus no intervention, Outcome 6 Fractional excretion of sodium.

Comparison 1 Dopamine and analogues versus no intervention, Outcome 7 Renal plasma flow (24 hours).
Figuras y tablas -
Analysis 1.7

Comparison 1 Dopamine and analogues versus no intervention, Outcome 7 Renal plasma flow (24 hours).

Comparison 2 Diuretics versus no intervention, Outcome 1 Mortality.
Figuras y tablas -
Analysis 2.1

Comparison 2 Diuretics versus no intervention, Outcome 1 Mortality.

Comparison 2 Diuretics versus no intervention, Outcome 2 Acute renal injury.
Figuras y tablas -
Analysis 2.2

Comparison 2 Diuretics versus no intervention, Outcome 2 Acute renal injury.

Comparison 2 Diuretics versus no intervention, Outcome 3 Urine output.
Figuras y tablas -
Analysis 2.3

Comparison 2 Diuretics versus no intervention, Outcome 3 Urine output.

Comparison 2 Diuretics versus no intervention, Outcome 4 Creatinine clearance.
Figuras y tablas -
Analysis 2.4

Comparison 2 Diuretics versus no intervention, Outcome 4 Creatinine clearance.

Comparison 3 Calcium channel blockers versus no intervention, Outcome 1 Mortality.
Figuras y tablas -
Analysis 3.1

Comparison 3 Calcium channel blockers versus no intervention, Outcome 1 Mortality.

Comparison 3 Calcium channel blockers versus no intervention, Outcome 2 Acute renal injury.
Figuras y tablas -
Analysis 3.2

Comparison 3 Calcium channel blockers versus no intervention, Outcome 2 Acute renal injury.

Comparison 3 Calcium channel blockers versus no intervention, Outcome 3 Urine output.
Figuras y tablas -
Analysis 3.3

Comparison 3 Calcium channel blockers versus no intervention, Outcome 3 Urine output.

Comparison 3 Calcium channel blockers versus no intervention, Outcome 4 Creatinine clearance.
Figuras y tablas -
Analysis 3.4

Comparison 3 Calcium channel blockers versus no intervention, Outcome 4 Creatinine clearance.

Comparison 3 Calcium channel blockers versus no intervention, Outcome 5 Free water clearance.
Figuras y tablas -
Analysis 3.5

Comparison 3 Calcium channel blockers versus no intervention, Outcome 5 Free water clearance.

Comparison 4 ACE inhibitors versus no intervention, Outcome 1 Mortality.
Figuras y tablas -
Analysis 4.1

Comparison 4 ACE inhibitors versus no intervention, Outcome 1 Mortality.

Comparison 4 ACE inhibitors versus no intervention, Outcome 2 Acute renal injury.
Figuras y tablas -
Analysis 4.2

Comparison 4 ACE inhibitors versus no intervention, Outcome 2 Acute renal injury.

Comparison 4 ACE inhibitors versus no intervention, Outcome 3 Renal plasma flow.
Figuras y tablas -
Analysis 4.3

Comparison 4 ACE inhibitors versus no intervention, Outcome 3 Renal plasma flow.

Comparison 5 Atrial natriuretic peptide versus no intervention, Outcome 1 Mortality.
Figuras y tablas -
Analysis 5.1

Comparison 5 Atrial natriuretic peptide versus no intervention, Outcome 1 Mortality.

Comparison 5 Atrial natriuretic peptide versus no intervention, Outcome 2 Acute renal injury.
Figuras y tablas -
Analysis 5.2

Comparison 5 Atrial natriuretic peptide versus no intervention, Outcome 2 Acute renal injury.

Comparison 5 Atrial natriuretic peptide versus no intervention, Outcome 3 Urine output at 24 hours.
Figuras y tablas -
Analysis 5.3

Comparison 5 Atrial natriuretic peptide versus no intervention, Outcome 3 Urine output at 24 hours.

Comparison 5 Atrial natriuretic peptide versus no intervention, Outcome 4 Creatinine clearance, 24 hours.
Figuras y tablas -
Analysis 5.4

Comparison 5 Atrial natriuretic peptide versus no intervention, Outcome 4 Creatinine clearance, 24 hours.

Comparison 5 Atrial natriuretic peptide versus no intervention, Outcome 5 Creatinine clearance, 2 to 3 days.
Figuras y tablas -
Analysis 5.5

Comparison 5 Atrial natriuretic peptide versus no intervention, Outcome 5 Creatinine clearance, 2 to 3 days.

Comparison 6 N‐Acetyl cysteine versus no intervention, Outcome 1 Mortality.
Figuras y tablas -
Analysis 6.1

Comparison 6 N‐Acetyl cysteine versus no intervention, Outcome 1 Mortality.

Comparison 6 N‐Acetyl cysteine versus no intervention, Outcome 2 Acute renal injury.
Figuras y tablas -
Analysis 6.2

Comparison 6 N‐Acetyl cysteine versus no intervention, Outcome 2 Acute renal injury.

Comparison 6 N‐Acetyl cysteine versus no intervention, Outcome 3 Urine output, 24 hours.
Figuras y tablas -
Analysis 6.3

Comparison 6 N‐Acetyl cysteine versus no intervention, Outcome 3 Urine output, 24 hours.

Comparison 7 Erythropoietin (EPO) versus control, Outcome 1 Mortality.
Figuras y tablas -
Analysis 7.1

Comparison 7 Erythropoietin (EPO) versus control, Outcome 1 Mortality.

Comparison 7 Erythropoietin (EPO) versus control, Outcome 2 Acute renal injury.
Figuras y tablas -
Analysis 7.2

Comparison 7 Erythropoietin (EPO) versus control, Outcome 2 Acute renal injury.

Comparison 7 Erythropoietin (EPO) versus control, Outcome 3 Urine output: 24 hours.
Figuras y tablas -
Analysis 7.3

Comparison 7 Erythropoietin (EPO) versus control, Outcome 3 Urine output: 24 hours.

Comparison 7 Erythropoietin (EPO) versus control, Outcome 4 Urine output: 2 to 3 days.
Figuras y tablas -
Analysis 7.4

Comparison 7 Erythropoietin (EPO) versus control, Outcome 4 Urine output: 2 to 3 days.

Comparison 7 Erythropoietin (EPO) versus control, Outcome 5 Urine output: 5 to 7 days.
Figuras y tablas -
Analysis 7.5

Comparison 7 Erythropoietin (EPO) versus control, Outcome 5 Urine output: 5 to 7 days.

Comparison 8 Intravenous fluid versus control, Outcome 1 Mortality.
Figuras y tablas -
Analysis 8.1

Comparison 8 Intravenous fluid versus control, Outcome 1 Mortality.

Comparison 8 Intravenous fluid versus control, Outcome 2 Acute renal injury.
Figuras y tablas -
Analysis 8.2

Comparison 8 Intravenous fluid versus control, Outcome 2 Acute renal injury.

Comparison 8 Intravenous fluid versus control, Outcome 3 Creatinine clearance.
Figuras y tablas -
Analysis 8.3

Comparison 8 Intravenous fluid versus control, Outcome 3 Creatinine clearance.

Comparison 9 Cardiac surgery: subgroup analysis, Outcome 1 Mortality.
Figuras y tablas -
Analysis 9.1

Comparison 9 Cardiac surgery: subgroup analysis, Outcome 1 Mortality.

Comparison 9 Cardiac surgery: subgroup analysis, Outcome 2 Acute renal injury.
Figuras y tablas -
Analysis 9.2

Comparison 9 Cardiac surgery: subgroup analysis, Outcome 2 Acute renal injury.

Comparison 9 Cardiac surgery: subgroup analysis, Outcome 3 Urine output.
Figuras y tablas -
Analysis 9.3

Comparison 9 Cardiac surgery: subgroup analysis, Outcome 3 Urine output.

Comparison 9 Cardiac surgery: subgroup analysis, Outcome 4 Creatinine clearance.
Figuras y tablas -
Analysis 9.4

Comparison 9 Cardiac surgery: subgroup analysis, Outcome 4 Creatinine clearance.

Comparison 9 Cardiac surgery: subgroup analysis, Outcome 5 Free water clearance.
Figuras y tablas -
Analysis 9.5

Comparison 9 Cardiac surgery: subgroup analysis, Outcome 5 Free water clearance.

Comparison 9 Cardiac surgery: subgroup analysis, Outcome 6 Fractional excretion of sodium.
Figuras y tablas -
Analysis 9.6

Comparison 9 Cardiac surgery: subgroup analysis, Outcome 6 Fractional excretion of sodium.

Comparison 10 Aortic surgery: subgroup analysis, Outcome 1 Mortality.
Figuras y tablas -
Analysis 10.1

Comparison 10 Aortic surgery: subgroup analysis, Outcome 1 Mortality.

Comparison 10 Aortic surgery: subgroup analysis, Outcome 2 Acute renal injury.
Figuras y tablas -
Analysis 10.2

Comparison 10 Aortic surgery: subgroup analysis, Outcome 2 Acute renal injury.

Comparison 10 Aortic surgery: subgroup analysis, Outcome 3 Urine output.
Figuras y tablas -
Analysis 10.3

Comparison 10 Aortic surgery: subgroup analysis, Outcome 3 Urine output.

Comparison 10 Aortic surgery: subgroup analysis, Outcome 4 Creatinine clearance.
Figuras y tablas -
Analysis 10.4

Comparison 10 Aortic surgery: subgroup analysis, Outcome 4 Creatinine clearance.

Comparison 10 Aortic surgery: subgroup analysis, Outcome 5 Free water clearance.
Figuras y tablas -
Analysis 10.5

Comparison 10 Aortic surgery: subgroup analysis, Outcome 5 Free water clearance.

Comparison 10 Aortic surgery: subgroup analysis, Outcome 6 Fractional excretion of sodium.
Figuras y tablas -
Analysis 10.6

Comparison 10 Aortic surgery: subgroup analysis, Outcome 6 Fractional excretion of sodium.

Comparison 10 Aortic surgery: subgroup analysis, Outcome 7 Renal plasma flow.
Figuras y tablas -
Analysis 10.7

Comparison 10 Aortic surgery: subgroup analysis, Outcome 7 Renal plasma flow.

Comparison 11 Biliary surgery: subgroup analysis, Outcome 1 Urine output.
Figuras y tablas -
Analysis 11.1

Comparison 11 Biliary surgery: subgroup analysis, Outcome 1 Urine output.

Comparison 11 Biliary surgery: subgroup analysis, Outcome 2 Creatinine clearance.
Figuras y tablas -
Analysis 11.2

Comparison 11 Biliary surgery: subgroup analysis, Outcome 2 Creatinine clearance.

Comparison 12 Studies on participants with pre‐existing renal impairment, Outcome 1 Mortality.
Figuras y tablas -
Analysis 12.1

Comparison 12 Studies on participants with pre‐existing renal impairment, Outcome 1 Mortality.

Comparison 12 Studies on participants with pre‐existing renal impairment, Outcome 2 Acute renal injury.
Figuras y tablas -
Analysis 12.2

Comparison 12 Studies on participants with pre‐existing renal impairment, Outcome 2 Acute renal injury.

Comparison 12 Studies on participants with pre‐existing renal impairment, Outcome 3 Urine output.
Figuras y tablas -
Analysis 12.3

Comparison 12 Studies on participants with pre‐existing renal impairment, Outcome 3 Urine output.

Comparison 12 Studies on participants with pre‐existing renal impairment, Outcome 4 Creatinine clearance.
Figuras y tablas -
Analysis 12.4

Comparison 12 Studies on participants with pre‐existing renal impairment, Outcome 4 Creatinine clearance.

Comparison 13 Studies with low risk of bias: sensitivity analysis, Outcome 1 Reported mortality, low risk of bias studies only.
Figuras y tablas -
Analysis 13.1

Comparison 13 Studies with low risk of bias: sensitivity analysis, Outcome 1 Reported mortality, low risk of bias studies only.

Comparison 13 Studies with low risk of bias: sensitivity analysis, Outcome 2 Acute renal injury, requiring dialysis, low risk of bias studies only.
Figuras y tablas -
Analysis 13.2

Comparison 13 Studies with low risk of bias: sensitivity analysis, Outcome 2 Acute renal injury, requiring dialysis, low risk of bias studies only.

Comparison 13 Studies with low risk of bias: sensitivity analysis, Outcome 3 Urine output at 24 hours, low risk of bias studies only.
Figuras y tablas -
Analysis 13.3

Comparison 13 Studies with low risk of bias: sensitivity analysis, Outcome 3 Urine output at 24 hours, low risk of bias studies only.

Comparison 13 Studies with low risk of bias: sensitivity analysis, Outcome 4 Creatinine clearance at 24 hours, low risk of bias studies only.
Figuras y tablas -
Analysis 13.4

Comparison 13 Studies with low risk of bias: sensitivity analysis, Outcome 4 Creatinine clearance at 24 hours, low risk of bias studies only.

Summary of findings for the main comparison. Interventions in patients with pre‐existing renal dysfunction

Interventions for protecting renal function in patients with pre‐existing renal impairment who are undergoing surgery

Patient or population: patients with pre‐existing renal impairment

Settings: perioperative period (7 days)

Intervention: interventions to protect the kidneys during the perioperative period

Comparison: placebo or no intervention

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No. of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Placebo or no intervention

Various interventions

Mortality in patients with pre‐existing renal impairment

As reported in the included trials

Folliow‐up: 7 days

Study population

OR 0.74 (0.36 to 1.52)

959
(10 studies)

⊕⊝⊝⊝
very lowa,b,c,d

Evidence is not strong and is of poor quality

38 per 1000

29 per 1000
(15 to 56)

Moderate

20 per 1000

15 per 1000

(8 to 30)

Acute renal injury in patients with pre‐existing renal impairment

As reported in the included trials

Follow‐up: 1 to 7 days

Study population

OR 0.40 (0.22 to 0.76)

979
(11 studies)

⊕⊝⊝⊝
very lowe,f,g,h

Evidence is not strong and is of poor quality (although it might give a statistical edge)

62 per 1000

28 per 1000
(15 to 50)

Moderate

40 per 1000

18 per 1000

(9 to 32)

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in the footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: Confidence interval; OR: Odds ratio.

GRADE Working Group grades of evidence:
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

aOnly six of the 10 studies showed low risk of bias.
bSignificant clinical heterogeneity between studies was noted.
cClinical heterogeneity and indications varied across the chosen studies.
dThe numbers of events and the total numbers of cases studied were small.
eOnly six of the 11 included studies were assessed as having low risk of bias.
fSsignificant clinical heterogeneity amongst the included studies was noted.
gClinical scenarios in the included studies varied.
hReported incidences were low and the numbers of participants in the included studies were small.

Figuras y tablas -
Summary of findings for the main comparison. Interventions in patients with pre‐existing renal dysfunction
Summary of findings 2. Interventions to protect the kidneys in the perioperative period in patients undergoing surgery: low ROB studies only

Interventions to protect the kidneys during the perioperative period in patients undergoing surgery: low ROB studies only

Patient or population: patients undergoing surgery
Settings: perioperative period (7 days)
Intervention: interventions to protect the kidneys in patients undergoing surgery: low ROB studies only

Comparison: placebo or no intervention

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No. of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control

Interventions to protect the kidneys:

low ROB cases only

Reported mortality, low risk of bias studies only
Follow‐up: mean 7 days

Study population

OR 1.01
(0.52 to 1.97)

1604
(19 studies)

⊕⊝⊝⊝
very lowa,b,c,d

Evidence is not strong and is of poor quality

23 per 1000

23 per 1000
(12 to 42)

Moderate

20 per 1000

20 per 1000
(11 to 37)

Acute renal injury, low‐risk studies only

Study population

OR 1.05
(0.55 to 2.03)

1550
(16 studies)

⊕⊝⊝⊝
very lowe,f,g,h

Evidence is not strong and is of poor quality (although it might give a statistical edge)

23 per 1000

24 per 1000
(13 to 45)

Moderate

0 per 1000

0 per 1000
(0 to 0)

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in the footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; OR: Odds ratio; ROB: Risk of bias.

GRADE Working Group grades of evidence:
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

aOnly six of the 10 studies showed low risk of bias.
bSignificant clinical heterogeneity between studies was noted.
cClinical heterogeneity and indications varied across the chosen studies.
dThe numbers of events and the total numbers of cases studied were small.
eOnly six of the 11 included studies were assessed as having low risk of bias.
fSignificant clinical heterogeneity amongst the included studies was noted.
gClinical scenarios in the included studies varied.
hReported incidences were low and the numbers of participants in the included studies were small.

Figuras y tablas -
Summary of findings 2. Interventions to protect the kidneys in the perioperative period in patients undergoing surgery: low ROB studies only
Table 1. Methodological quality of included studies

Study ID

Randomization

Allocation concealment

Blinding

Withdrawals recorded

Overall quality

Adabag 2008

Randomly assigned by the investigational pharmacist

Block randomization (blocks of 10)

Participants, researchers and clinicians blinded to treatment assignment

 

Participants, researchers and clinicians (including data collecting nurse) blinded

Drug packets matched in volume, colour, consistency and transparency and given mixed with fruit juice to mask taste

Not reported

Good

Amano 1994

‘Randomly assigned’ into two groups

None described

None described; control group had no treatment

Not described

Poor

Amano 1995

‘Patients were randomized into either diltiazem or no treatment'

Not described

None described; control group had no treatment

Not described

Poor

Ascione 1999

‘Prospectively randomized by card allocation’

‘Prospectively randomized by card allocation’

Not used

Not discussed

Moderate

Barr 2008

Randomization done by pharmacy department; method of randomization uncertain

Not sure about adequacy of randomization

No specific mention of allocation concealment except to say ‘double‐blinded’

Allocation concealment inadequate

No specific mention of who all were blinded; ‘double‐blinded’, placebo‐controlled trial

Not sure whether blinding was adequate

One withdrawal from study reported

Moderate

Berendes 1997

‘Placebo controlled prospective study’; no randomization

None described

None described

Not described

Poor

Bergman 2002

‘Consented and were randomized’

Not described

Not used

3 participants (2, 1) not operated upon; 2 participants excluded from final analysis because of clinical management changes

Poor

Burns 2005

Randomization done by pharmacy trial co‐ordinator using a permitted block strategy

Allocation concealment using central randomization with drugs prepared by pharmacy

Quadruple‐blinded (participants, clinicians, data collectors and data analyst) placebo‐controlled study

Clearly accounted for (5 in intervention group and 2 in control group)

Good

Carcoana 2003

‘Prospective randomized double‐blinded and placebo‐controlled study’

Computer‐generated random number tables

Not specifically described, but quite likely it was concealed allocation

Blinded manner; drug or saline supplied by the department investigational pharmacy in a blinded manner +  additive for the CPB circuit prime (mannitol or saline, supplied similarly)

All allocated participants completed the trial (withdrawals before allocation)

Good

Chen 2007

‘Randomized’; no details provided

‘Double‐blind, placebo‐controlled proof of concept trial’

No details provided

‘Double‐blind, placebo‐controlled proof of concept trial’

No details provided

‘Double‐blind, placebo‐controlled proof of concept trial’

Four withdrawals from trial reported

 

Poor

Cho 2009

Computer‐generated randomization method used

Computer allocation, no further details given

Not described except by the statement, ‘investigator blinded to the study group evaluated the postoperative data’

Not reported

Moderate

Cogliati 2007

Randomization from a computer list, in an envelope

Sealed envelope used

‘All personnel and patients were blinded to the assignment’

Blinded nurse, not involved with study, prepared the drug/ placebo in identical 50 mL filled syringes

‘All personnel and patients were blinded to the assignment’

1 participant

Good

Colson 1990

Allocated in a randomized double‐blind fashion to 2 groups

No details on randomization method

Allocated in a randomized double‐blind fashion to 2 groups

No description of allocation concealment

No details on blinding except ‘double‐blind fashion’

Not given

Poor

Colson 1992

Allocated in a randomized double‐blind fashion to 2 groups

No details on randomization method

Allocated in a randomized double‐blind fashion to 2 groups

No description of allocation concealment

No details on blinding except ‘double‐blind fashion’

Not given

Poor

Costa 1990

 

Participants with renal dysfunction (CCl < 50 mL/min)

‘Randomly divided into 3 groups’; no description of randomization

No description of allocation

No description of blinding

Not given

Poor

Cregg 1999

‘Randomly allocated’ into 3 groups; no description of randomization

No description of allocation

No description of blinding

Not given

Poor

Dawidson 1991

‘Randomized to either treatment group’ by pulling a card from a previously prepared deck

No description of allocation concealment

No details on blinding

Not given

Poor

de Lasson 1995

‘Randomly allocated into infusion of dopamine or placebo’ by one of the authors, who was unaware of the treatment allocation

 

‘Randomly allocated into infusion of dopamine or placebo’ by one of the authors, who was unaware of the treatment allocation; no description of allocation concealment

 

No blinding described

Not given

Poor

de Lasson 1997

Randomization and drug or placebo preparation provided by drug company; method not described, but likely to be good

Not sure of any allocation concealment, but likely possible

Possible, but blinded tables not described

1 participant had additional drugs but was not excluded

Moderate

Dehne 2001

Randomly allocated into 2 groups, randomization method not described

Allocation concealment not described

Blinding not mentioned

All participants accounted for in calculations

Poor

Donmez 1998

‘Randomly allocated into 3 groups’; method of randomization not described

‘Randomly allocated into 3 groups’; method of allocation concealment not described

‘Randomly allocated into 3 groups’; method of blinding not described

Dropouts not described

Poor

Dural 2000

‘Randomly allocated into 3 groups’; method of randomization not described

‘Randomly allocated into 3 groups’; method of allocation concealment not described

‘Randomly allocated into 3 groups’; method of blinding not described

Dropouts not described

Poor

Durmaz 2003

Randomization done by the last digit of the medical record number of participant (quasi‐randomization)

‘Patients were prospectively allocated into 2 groups’

No details given

Not given

Not given

Poor

Fischer 2005

Retrospective chart review of a randomized trial in 2003, which used computer‐generated allocation list (randomly permuted blocks of random size) provided by department of Medical Statistics

Computer‐generated allocation list (randomly permuted blocks of random size) provided by department of Medical Statistics

Drugs supplied in identical looking glass vials containing drug or placebo

Exclusions described in text

Good

Gubern 1988

 

’Prospectively randomized’; no details of method of randomization

’Prospectively randomized’; no details of method of allocation

’Prospectively randomized’; no details of method of blinding

Fate of participants discussed

Poor

Haase 2007

Random assignment of participants using Microsoft Excel‐based random number generation to create a randomization list, in blocks of 10

Allocation concealment ensured by quadruple‐blinding (participants, clinicians, data collectors and data analysers  were unaware of groups or treatment)

Quadruple‐blinding (participants, clinicians, data collectors and data analysers were blinded)

0 participants

Good

Haase 2009

Microsoft Excel‐based random number generation, with blocks of 10; central randomization by department of pharmacy

Allocation concealment achieved by central randomization, blinding to all researchers, participants and others. Allocation revealed only after data analysis

Both fluids in separate shrink‐wrapped black plastic bags that were identical in appearance (blinded to participants, anaesthetists, surgeons, ICU personnel, nurses and others)

1 in each group

Good

Halpenny 2002

‘Random allocation used’; method not given

‘Random allocation used’; method not given

‘Random allocation used’; method not given

1 participant excluded from the trial

Poor

Harten 2008

‘Randomized’, but no details given

Allocated to control and intervention groups using opaque envelopes immediately before surgery; not sure whether allocation was maintained

No blinding

1 died before operation (intervention group)

Poor 

Hynninen 2006

Random assignment in blocks of 10

done by hospital pharmacy, no details given

Allocation done by hospital pharmacy

Clinical and study personnel not aware of study allocation

Blinding quite likely, although not detailed in text

1 participant withdrew from study intraoperatively

(does not mention which group, although most likely the intervention group-1 less in that group)

Moderate

Kaya 2007

Computer‐generated randomization done by statistician

Sequentially numbered, sealed envelopes

 

SNP and saline in uniformly appearing 50 mL syringes, blinded to surgeons, perfusionists and nurses; investigators did not know the details

None

Good

Kleinschmidt 1997

Randomization by computer

Not described in detail

Not described in detail

No detailed description

Poor

Kramer 2002

Participants randomly assigned to receive 1 of 2 treatments

No details given

No details given

Early termination of study in 33 of 56 participants; ITT used

Poor

Kulka 1996

Allocated into 2 groups in a double‐blinded random fashion; no details of randomization given

Allocated into 2 groups in a double‐blinded random fashion; no details of allocation given

Allocated into 2 groups in a double‐blinded random fashion; no details of blinding given

2 participants excluded

Poor

Lassnigg 2000

Placebo‐controlled randomized double‐blind trial; block randomization done and sealed envelopes used

Placebo‐controlled randomized double‐blind trial; block randomizations done with the use of sealed envelopes; no further details on allocation concealment provided

Placebo‐controlled randomized double‐blind trial; no other details of blinding provided

3 participants excluded from analysis

Moderate

Lau 2001

‘Recruited patients were allocated to one of 2 groups’; no details on randomization

‘Recruited patients were allocated to one of 2 groups’; no details on allocation concealment

‘Recruited patients were allocated to one of 2 groups’; no details on blinding provided

2 participants accounted for

Poor

Licker 1996

'Patients were allocated in a randomized double‐blind manner’; no details of randomization given

'Patients were allocated in a randomized double‐blind manner’; no details of allocation concealment given

'Patients were allocated in a randomized double‐blind manner’; no details of blinding given

2 participants excluded from the trial

Poor

Loef 2004

‘Randomized in a double‐blind fashion’; no details of randomization given

‘Randomized in a double‐blind fashion’; no details of allocation given

‘Randomized in a double‐blind fashion’; no details of blinding given

All participants completed the trial

Poor

Marathias 2006

Used a 2:1 ratio in randomization process, participants randomly assigned into groups; no other details of randomization given

Participants randomly assigned into groups; no other details of allocation given

Participants randomly assigned into groups; no other details of blinding given

Not given

Poor

Mitaka 2008

‘Patients were randomized into 2 groups’; not sure what method of randomization was used

Not sure how allocation was performed

‘Blind infusion was performed’; not sure about blinding

None indicated

Poor

Morariu 2005

Designed as a prospective double‐blind placebo‐controlled randomized trial; no other details of randomization provided

Prospective double‐blind placebo‐controlled randomized trial; no other details of allocation concealment provided

Prospective double‐blind placebo‐controlled randomized trial; no other details of blinding provided

All participants competed the trial

Poor

Morgera 2002

‘Patients were randomized’; no other details given

‘Patients were randomized’; no other details given

‘Patients were randomized’; no other details given

2 participants excluded from analysis

Poor

Myles 1993

Randomly assigned with the use of a table of random numbers; ‘prospective double‐blind randomized trial’

Coded 50 mL syringes from the pharmacy, with contents remaining unknown to investigators until the end of the trial; allocation concealed

Coded 50 mL syringes from the pharmacy, with contents remaining unknown to investigators until the end of the trial; blinded

3 withdrawals before start of trial

Good

Nicholson 1996

‘Prospective randomized trial’; no further details on randomization

‘Prospective randomized trial’; no further details on allocation

‘Prospective randomized trial’; no details on blinding

None reported

Poor

Nouri‐Majalan 2009

‘Patients were randomized’; no further details

No indication of allocation concealment, but for statement, ‘To prevent bias, surgeons, nurses, and lab technicians were blinded to patient assignment’

Possible:

‘To prevent bias, surgeons, nurses, and lab technicians were blinded to patient assignment’

None indicated in text

Poor

O'Hara 2002

‘Prospective randomized study’; no further details on randomization given

‘Prospective randomized study’; no further details on allocation

‘Prospective randomized study’; no further details on blinding

11 of 35 excluded

Poor

Parks 1994

‘Patients were randomly allocated into 2 groups’; no further details on randomization

‘Patients were randomly allocated into 2 groups’; no further details on allocation

‘Patients were randomly allocated into 2 groups’; no further details on blinding

Not disclosed

Poor

Perez 2002

Randomization performed by aleatorized numbers prepared in closed envelopes

No details on concealment of allocation except ‘Randomization performed by aleatorized numbers prepared in closed envelopes’

Drug or placebo given with an identical container in a double‐blind manner with the same volume of drug or saline

4 participants excluded

Moderate

Prasad 2010

Randomized, prospective, open‐label study

Random number generated from a random number table

No concealment of assignment

No blinding

4 excluded after randomization?

Poor

Prowle 2012

Random assignment by the  hospital pharmacy clinical trials co‐ordinator

Microsoft Excel–based random number generator permuted block strategy with blocks of 10

Allocation stratified into 2 groups based on pre‐op use of statins

Allocation concealed to participants, anaesthetists, cardiac surgeons, intensive care specialists, bedside nurses and investigators

'Double‐blind'. Atorvastatin or placebo medication prepared in capsules of identical appearance

 

8 in intervention group and 7 in control group

Good

Pull Ter Gunne 1990

Random assignment into 2 groups; no further details

Random assignment into 2 groups; no further details

Random assignment into 2 groups; no further details; the anaesthesiologist was aware of the allocation and treatment received

No details provided

Poor

Ristikankare 2006

‘Randomly allocated in a double‐blinded manner; the hospital pharmacy performed the randomization and prepared the study medications’

‘Randomly allocated in a double‐blinded manner; the hospital pharmacy performed the randomization and prepared the study medications’, but no details of allocation concealment provided

‘Randomly allocated in a double‐blinded manner; the hospital pharmacy performed the randomization and prepared the study medications’; no details of blinding provided

3 participants excluded

Moderate

Ryckwaert 2001

‘Patients were allocated in a randomized double‐blind fashion to 2 groups’; no further details of randomization given

‘Patients were allocated in a randomized double‐blind fashion to 2 groups’; no further details of allocation given

‘Patients were allocated in a randomized double‐blind fashion to 2 groups’; no further details of blinding given

No dropouts detailed in text

Poor

Sezai 2000

‘Randomly allocated to two groups receiving blind infusion of drug or placebo’; no other details on randomization method

‘Randomly allocated to two groups receiving blind infusion of drug or placebo’; no other details on allocation method

‘Randomly allocated to two groups receiving blind infusion of drug or placebo’; no other details on blinding

Not described, but study probably had no dropouts

Poor

Sezai 2009

Randomly allocated into 2 groups by drawing lots

‘Randomly allocated by drawing lots’

No other details

No evidence of blinding

No mention in the text

Poor

Sezai 2011

Randomly allocated into 2 groups by lottery method

'Randomly allocated into 2 groups'; no evidence of concealment of allocation

No blinding discussed

Dropouts discussed

Poor

Shackford 1983

Participants were assigned by random number to 1 of 2 groups; no details on randomization given

Participants were assigned by random number to 1 of 2 groups; no details on concealment of allocation given

Participants assigned by random number to 1 of 2 groups; no details on blinding

No dropouts

Poor

Shim 2007

Participants randomly allocated to 1 of 2 groups with use of a computer‐generated randomization table

Participants randomly allocated to 1 of 2 groups with use of a computer‐generated randomization table; no further details on allocation concealment given

All medical personnel involved in the study blinded to the contents of the infusion bottle

No dropouts recorded

Moderate

Song 2009

Block randomization developed by research centre Randomization stratified by serum creatinine levels

Allocation via Internet using predetermined randomization

Participants, healthcare clinicians and researchers blinded

None

Good

Tang 1999

Prospectively randomly assigned

No details on allocation provided in text

No details of blinding provided in text

No dropouts recorded

Poor

Tang 2002

Participants randomly assigned; no further details on randomization given

Participants randomly assigned; no further details on allocation given

2 different types of procedures; no blinding possible

5 participants subsequently excluded from trial

Poor

Thompson 1986

‘Patients were randomized’; no more details

‘Patients were randomized’; no more details

No details provided

‘There were no withdrawals’

Poor

Turner 2008

Random assignment done with use of computer‐generated randomization list

Computer‐generated randomization list placed in sealed envelopes and opened in numerical order by a third party, who prepared the study infusion

Third party prepared the infusion. Infusions were such that volumes were equal in the bag and of identical colour, and contents of the bag were indistinguishable; the infusion was done over 30 minutes to avoid haemodynamic effects of treatment

Yes, none lost

Good

Urzua 1992

Participants randomly assigned into 1 of 2 groups, according to the last digit of their clinical history number (quasi‐randomization)

No description of concealment of allocation

No report of blinding

All participants completed

Poor

Wahbah 2000

‘Patients were randomly allocated into 4 equal groups’; no further details on randomization

Patients were randomly allocated into 4 equal groups’; no further details on allocation

No description of blinding

None described

Poor

Welch 1995

‘Patients were randomly assigned’; no further details on randomization method used

‘Patients were randomly assigned’; no further details on allocation method used

No description of blinding

None described

Poor

Wijnen 2002

‘Patients were randomized’; no further details on method of randomization used

‘Patients were randomized’; no details on method of allocation used

No details on blinding

One death described

Poor

Witczak 2008

Participants were ‘randomized’

It appears that the anaesthesiologist ‘randomly drew an envelope with the assigned treatment’

Allocation concealment was possible only for participants and the statistician

No; control received no treatment

Participants and the statistician were blinded

Not described

Poor

Woo 2002

‘Patients were randomized’; no further details on method of randomization used

‘Patients were randomized’; no details on method of allocation used

No details on blinding

8 participants excluded because of death or major complications

Poor

Yavuz 2002A

‘Patients were prospectively randomized’; no details on method of randomization used

‘Patients were prospectively randomized’; no details on method of allocation used

No description of blinding

States no deaths; no description of dropouts

Poor

Yavuz 2002B

‘Patients randomized into 4 groups’; no further details on randomization given

‘Patients randomized into 4 groups’; no description of allocation used

No description of blinding

No mortality described, but no suggestion of dropouts

Poor

Zanardo 1993

‘Randomly assigned’; no further details of randomization given

‘Randomly assigned’; no further details of allocation given

No blinding described

No dropouts described

Poor

Figuras y tablas -
Table 1. Methodological quality of included studies
Comparison 1. Dopamine and analogues versus no intervention

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mortality Show forest plot

11

583

Peto Odds Ratio (Peto, Fixed, 95% CI)

1.50 [0.48, 4.73]

2 Acute renal injury Show forest plot

10

541

Peto Odds Ratio (Peto, Fixed, 95% CI)

1.36 [0.44, 4.23]

3 Urine output Show forest plot

13

Mean Difference (IV, Random, 95% CI)

Subtotals only

3.1 24 hours (mL/min)

13

670

Mean Difference (IV, Random, 95% CI)

0.18 [‐0.19, 0.54]

3.2 2 to 4 days (mL/min)

7

380

Mean Difference (IV, Random, 95% CI)

0.51 [0.04, 0.97]

3.3 5 to 7 days (mL/min)

4

103

Mean Difference (IV, Random, 95% CI)

0.23 [‐0.06, 0.51]

4 Creatinine clearance Show forest plot

15

Mean Difference (IV, Random, 95% CI)

Subtotals only

4.1 24 hours (mL/min)

14

616

Mean Difference (IV, Random, 95% CI)

7.17 [‐5.53, 19.86]

4.2 2 to 4 days (mL/min)

9

459

Mean Difference (IV, Random, 95% CI)

7.31 [‐6.19, 20.82]

4.3 5 to 7 days (mL/min)

5

115

Mean Difference (IV, Random, 95% CI)

‐3.33 [‐13.63, 6.98]

5 Free water clearance Show forest plot

6

Mean Difference (IV, Random, 95% CI)

Subtotals only

5.1 24 hours (mL/min)

6

166

Mean Difference (IV, Random, 95% CI)

0.03 [‐0.17, 0.22]

6 Fractional excretion of sodium Show forest plot

5

Mean Difference (IV, Random, 95% CI)

Totals not selected

6.1 24 hours (%)

5

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

7 Renal plasma flow (24 hours) Show forest plot

2

48

Mean Difference (IV, Random, 95% CI)

75.36 [‐63.27, 213.98]

Figuras y tablas -
Comparison 1. Dopamine and analogues versus no intervention
Comparison 2. Diuretics versus no intervention

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mortality Show forest plot

4

255

Peto Odds Ratio (Peto, Fixed, 95% CI)

2.49 [0.80, 7.74]

2 Acute renal injury Show forest plot

5

305

Peto Odds Ratio (Peto, Fixed, 95% CI)

2.39 [0.68, 8.47]

3 Urine output Show forest plot

4

Mean Difference (IV, Random, 95% CI)

Subtotals only

3.1 24 hours (mL/min)

4

141

Mean Difference (IV, Random, 95% CI)

0.10 [‐0.12, 0.33]

3.2 2 to 4 days (mlL/min)

2

89

Mean Difference (IV, Random, 95% CI)

0.15 [‐0.14, 0.45]

4 Creatinine clearance Show forest plot

4

Mean Difference (IV, Random, 95% CI)

Subtotals only

4.1 24 hours (mL/min)

3

123

Mean Difference (IV, Random, 95% CI)

‐18.02 [‐41.78, 5.75]

4.2 2 to 4 days (mL/min)

3

120

Mean Difference (IV, Random, 95% CI)

2.33 [‐14.76, 19.42]

Figuras y tablas -
Comparison 2. Diuretics versus no intervention
Comparison 3. Calcium channel blockers versus no intervention

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mortality Show forest plot

2

68

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 Acute renal injury Show forest plot

6

172

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.11 [0.01, 1.17]

3 Urine output Show forest plot

4

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

3.1 Urine output: 24 hours (mL/min)

4

170

Mean Difference (IV, Fixed, 95% CI)

0.23 [0.02, 0.45]

4 Creatinine clearance Show forest plot

5

Mean Difference (IV, Random, 95% CI)

Subtotals only

4.1 24 hours (mL/min)

5

251

Mean Difference (IV, Random, 95% CI)

4.74 [‐3.30, 12.77]

4.2 2 to 4 days (mL/min)

2

130

Mean Difference (IV, Random, 95% CI)

13.92 [‐24.62, 52.46]

5 Free water clearance Show forest plot

3

Mean Difference (IV, Random, 95% CI)

Subtotals only

5.1 24 hours (mL/min)

3

91

Mean Difference (IV, Random, 95% CI)

‐0.09 [‐0.47, 0.29]

Figuras y tablas -
Comparison 3. Calcium channel blockers versus no intervention
Comparison 4. ACE inhibitors versus no intervention

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mortality Show forest plot

1

14

Peto Odds Ratio (Peto, Fixed, 95% CI)

7.39 [0.15, 372.38]

2 Acute renal injury Show forest plot

3

64

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.0 [0.0, 0.0]

3 Renal plasma flow Show forest plot

3

Mean Difference (IV, Random, 95% CI)

Subtotals only

3.1 RPF: end of operation (mL/min)

3

62

Mean Difference (IV, Random, 95% CI)

46.37 [‐68.61, 161.34]

Figuras y tablas -
Comparison 4. ACE inhibitors versus no intervention
Comparison 5. Atrial natriuretic peptide versus no intervention

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mortality Show forest plot

3

825

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.52 [0.19, 1.44]

2 Acute renal injury Show forest plot

4

865

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.23 [0.08, 0.64]

3 Urine output at 24 hours Show forest plot

3

584

Mean Difference (IV, Random, 95% CI)

0.42 [0.18, 0.67]

4 Creatinine clearance, 24 hours Show forest plot

5

905

Mean Difference (IV, Random, 95% CI)

35.23 [‐0.48, 70.94]

5 Creatinine clearance, 2 to 3 days Show forest plot

5

905

Mean Difference (IV, Random, 95% CI)

27.30 [4.36, 50.23]

Figuras y tablas -
Comparison 5. Atrial natriuretic peptide versus no intervention
Comparison 6. N‐Acetyl cysteine versus no intervention

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mortality Show forest plot

6

641

Peto Odds Ratio (Peto, Fixed, 95% CI)

1.01 [0.42, 2.42]

2 Acute renal injury Show forest plot

5

601

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.91 [0.32, 2.62]

3 Urine output, 24 hours Show forest plot

2

146

Mean Difference (IV, Random, 95% CI)

0.18 [‐0.24, 0.60]

Figuras y tablas -
Comparison 6. N‐Acetyl cysteine versus no intervention
Comparison 7. Erythropoietin (EPO) versus control

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mortality Show forest plot

1

71

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.13 [0.00, 6.63]

2 Acute renal injury Show forest plot

1

71

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.0 [0.0, 0.0]

3 Urine output: 24 hours Show forest plot

1

71

Mean Difference (IV, Random, 95% CI)

‐0.13 [‐0.47, 0.21]

4 Urine output: 2 to 3 days Show forest plot

1

71

Mean Difference (IV, Random, 95% CI)

‐0.19 [‐0.56, 0.18]

5 Urine output: 5 to 7 days Show forest plot

1

71

Mean Difference (IV, Random, 95% CI)

‐0.14 [‐0.50, 0.22]

Figuras y tablas -
Comparison 7. Erythropoietin (EPO) versus control
Comparison 8. Intravenous fluid versus control

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mortality Show forest plot

4

152

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.75 [0.16, 3.42]

2 Acute renal injury Show forest plot

3

123

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.22 [0.05, 0.96]

3 Creatinine clearance Show forest plot

2

Mean Difference (IV, Random, 95% CI)

Subtotals only

3.1 24 hours (mL/min)

2

77

Mean Difference (IV, Random, 95% CI)

‐10.34 [‐29.57, 8.88]

Figuras y tablas -
Comparison 8. Intravenous fluid versus control
Comparison 9. Cardiac surgery: subgroup analysis

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mortality Show forest plot

26

2390

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.96 [0.56, 1.64]

2 Acute renal injury Show forest plot

31

2504

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.55 [0.32, 0.92]

3 Urine output Show forest plot

19

Mean Difference (IV, Random, 95% CI)

Subtotals only

3.1 24 hours (mL/min)

17

1475

Mean Difference (IV, Random, 95% CI)

0.26 [0.17, 0.36]

3.2 2 to 3 days (mL/min)

9

1058

Mean Difference (IV, Random, 95% CI)

0.21 [‐0.13, 0.54]

4 Creatinine clearance Show forest plot

27

Mean Difference (IV, Random, 95% CI)

Subtotals only

4.1 24 hours (mL/min)

24

2136

Mean Difference (IV, Random, 95% CI)

9.38 [‐5.99, 24.74]

4.2 2 to 3 days (mL/min)

17

1844

Mean Difference (IV, Random, 95% CI)

14.21 [3.58, 24.85]

4.3 5 to 7 days (mL/min)

7

949

Mean Difference (IV, Random, 95% CI)

14.99 [0.84, 29.13]

5 Free water clearance Show forest plot

8

Mean Difference (IV, Random, 95% CI)

Subtotals only

5.1 24 hours (mL/min)

7

700

Mean Difference (IV, Random, 95% CI)

‐0.02 [‐0.22, 0.19]

5.2 2 to 3 days (mL/min)

4

591

Mean Difference (IV, Random, 95% CI)

‐0.29 [‐0.30, ‐0.28]

6 Fractional excretion of sodium Show forest plot

9

Mean Difference (IV, Random, 95% CI)

Totals not selected

6.1 24 hours (%)

8

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

6.2 2 to 4 days (%)

3

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

Figuras y tablas -
Comparison 9. Cardiac surgery: subgroup analysis
Comparison 10. Aortic surgery: subgroup analysis

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mortality Show forest plot

8

236

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.76 [0.20, 2.89]

2 Acute renal injury Show forest plot

8

284

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.62 [0.11, 3.70]

3 Urine output Show forest plot

7

Mean Difference (IV, Random, 95% CI)

Subtotals only

3.1 24 hours (mL/min)

7

227

Mean Difference (IV, Random, 95% CI)

0.04 [‐0.10, 0.19]

3.2 2 to 3 days (mL/min)

3

95

Mean Difference (IV, Random, 95% CI)

0.26 [‐0.06, 0.58]

3.3 5 to 7 days (mL/min)

2

55

Mean Difference (IV, Random, 95% CI)

‐0.09 [‐0.39, 0.21]

4 Creatinine clearance Show forest plot

9

Mean Difference (IV, Random, 95% CI)

Subtotals only

4.1 24 hours (mL/min)

9

323

Mean Difference (IV, Random, 95% CI)

7.99 [‐0.77, 16.74]

4.2 2 to 3 days (mL/min)

5

195

Mean Difference (IV, Random, 95% CI)

11.62 [‐6.13, 29.37]

4.3 5 to 7 days (mL/min)

4

116

Mean Difference (IV, Random, 95% CI)

‐12.85 [‐26.41, 0.72]

5 Free water clearance Show forest plot

5

Mean Difference (IV, Random, 95% CI)

Subtotals only

5.1 24 hours (mL/min)

5

154

Mean Difference (IV, Random, 95% CI)

‐0.25 [‐0.51, 0.01]

5.2 2 to 4 days (mL/min)

2

85

Mean Difference (IV, Random, 95% CI)

0.37 [‐0.12, 0.85]

5.3 5 to 7 days (mL/min)

2

85

Mean Difference (IV, Random, 95% CI)

0.24 [‐0.13, 0.61]

6 Fractional excretion of sodium Show forest plot

5

Mean Difference (IV, Random, 95% CI)

Totals not selected

6.1 24 hours (%)

5

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

6.2 2 to 4 days (%)

2

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

7 Renal plasma flow Show forest plot

4

Mean Difference (IV, Random, 95% CI)

Subtotals only

7.1 End of operation (mL/min)

2

44

Mean Difference (IV, Random, 95% CI)

50.29 [‐92.83, 193.40]

7.2 24 hours (mL/min)

2

47

Mean Difference (IV, Random, 95% CI)

45.86 [‐18.64, 110.36]

Figuras y tablas -
Comparison 10. Aortic surgery: subgroup analysis
Comparison 11. Biliary surgery: subgroup analysis

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Urine output Show forest plot

2

Mean Difference (IV, Random, 95% CI)

Subtotals only

1.1 Urine output: 24 hours (mL/min)

2

43

Mean Difference (IV, Random, 95% CI)

‐0.59 [‐0.99, ‐0.19]

1.2 Urine output: 2 to 4 days (mL/min)

2

43

Mean Difference (IV, Random, 95% CI)

0.24 [‐0.22, 0.69]

1.3 Urine output: 5 to 7 days (mL/min)

2

43

Mean Difference (IV, Random, 95% CI)

0.23 [0.09, 0.37]

2 Creatinine clearance Show forest plot

4

Mean Difference (IV, Random, 95% CI)

Subtotals only

2.1 24 hours (mL/min)

3

83

Mean Difference (IV, Random, 95% CI)

‐2.84 [‐14.07, 8.39]

2.2 2 to 4 days (mL/min)

3

74

Mean Difference (IV, Random, 95% CI)

0.42 [‐16.68, 17.52]

2.3 5 to 7 days (mL/min)

2

43

Mean Difference (IV, Random, 95% CI)

0.58 [‐16.43, 17.60]

Figuras y tablas -
Comparison 11. Biliary surgery: subgroup analysis
Comparison 12. Studies on participants with pre‐existing renal impairment

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mortality Show forest plot

10

959

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.74 [0.36, 1.52]

2 Acute renal injury Show forest plot

11

979

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.40 [0.22, 0.76]

3 Urine output Show forest plot

4

707

Mean Difference (IV, Random, 95% CI)

0.35 [‐0.16, 0.85]

3.1 Urine output, 24 hours

4

416

Mean Difference (IV, Random, 95% CI)

0.35 [‐0.12, 0.81]

3.2 Urine output, 2 to 3 days

2

291

Mean Difference (IV, Random, 95% CI)

0.43 [‐0.78, 1.65]

4 Creatinine clearance Show forest plot

4

646

Mean Difference (IV, Random, 95% CI)

10.65 [0.04, 21.27]

4.1 Creatinine clearance, 24 hours

4

347

Mean Difference (IV, Random, 95% CI)

7.78 [‐10.39, 25.94]

4.2 Creatinine clearance, 2 to 3 days

3

299

Mean Difference (IV, Random, 95% CI)

14.16 [‐6.20, 34.52]

Figuras y tablas -
Comparison 12. Studies on participants with pre‐existing renal impairment
Comparison 13. Studies with low risk of bias: sensitivity analysis

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Reported mortality, low risk of bias studies only Show forest plot

19

1604

Peto Odds Ratio (Peto, Fixed, 95% CI)

1.01 [0.52, 1.97]

2 Acute renal injury, requiring dialysis, low risk of bias studies only Show forest plot

16

1550

Peto Odds Ratio (Peto, Fixed, 95% CI)

1.05 [0.55, 2.03]

3 Urine output at 24 hours, low risk of bias studies only Show forest plot

11

798

Mean Difference (IV, Random, 95% CI)

0.20 [‐0.04, 0.44]

4 Creatinine clearance at 24 hours, low risk of bias studies only Show forest plot

9

817

Mean Difference (IV, Random, 95% CI)

6.59 [‐3.53, 16.72]

Figuras y tablas -
Comparison 13. Studies with low risk of bias: sensitivity analysis