The Role of Natriuretic Peptide Administration in Cardiovascular Surgery–Associated Renal Dysfunction: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

• Published in: Journal of cardiothoracic and vascular anesthesia Vol. 23; no. 2; pp. 151 - 160
• Main Authors: Nigwekar, Sagar U., MD, Hix, John K., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-04-2009
• Subjects: Acute Kidney Injury - etiology; Acute Kidney Injury - prevention & control; Acute Kidney Injury - therapy; acute renal failure; Adult; Aged; Aldosterone - blood; Anesthesia & Perioperative Care; Biomarkers; cardiac surgery; Cardiovascular Surgical Procedures - adverse effects; Creatinine - blood; Critical Care; Female; Humans; Male; Middle Aged; Models, Statistical; natriuretic peptides; Natriuretic Peptides - adverse effects; Natriuretic Peptides - therapeutic use; Perioperative Care; Postoperative Complications - prevention & control; Randomized Controlled Trials as Topic; Renal Dialysis - utilization; Reproducibility of Results; Respiration, Artificial; Treatment Outcome; vascular surgery; natriuretic peptides; cardiac surgery; acute renal failure; vascular surgery
• ISSN: 1053-0770; 1532-8422
• DOI: 10.1053/j.jvca.2008.11.007

Objective Randomized controlled trials involving natriuretic peptide administration in the perioperative cardiovascular setting have shown inconsistent effects for renal and other clinical endpoints. The authors aimed to systematically review these trials to ascertain the role of natriuretic peptide administration in the management of cardiovascular surgery–associated renal dysfunction. Design A systematic review and meta-analysis. Setting A hospital. Participants A total of 934 adult patients from 13 randomized controlled trials. Interventions Natriuretic peptides. Measurements and Main Results MEDLINE, EMBASE, Cochrane Renal Health Library, and Google scholar were searched independently by 2 reviewers for randomized controlled studies comparing natriuretic peptides with placebo in patients undergoing cardiovascular surgeries. Studies reporting data on renal outcomes were included. Two reviewers independently assessed the studies for eligibility and extracted the relevant data. The pooled estimate showed that natriuretic peptide administration was associated with a reduction in acute renal failure requiring dialysis (odds ratio = 0.32 [0.15-0.66]) and a statistically nonsignificant trend toward a reduction in 30-day or in-hospital mortality (odds ratio = 0.59 [0.31-1.12]). Other benefits were a reduction in postsurgery peak serum creatinine levels, an increase in postsurgery urine output, a reduction in postsurgery serum aldosterone levels, and reductions in mechanical ventilation duration and intensive care unit stay length. Most of the included studies addressing this topic were small and lacked adequate power to reach statistical significance on their own. Conclusions Current literature analyzing studies evaluating the administration of natriuretic peptides in cardiovascular surgery may be associated with significant improvements in clinical outcomes. Given the limitations of meta-analysis, these observations need to be confirmed in a larger, adequately powered, prospective multicenter study.