Reducing mortality in acute kidney injury patients: systematic review and international web-based survey.

Abstract

OBJECTIVE:

To identify all interventions that increase or reduce mortality in patients with acute kidney injury (AKI) and to establish the agreement between stated beliefs and actual practice in this setting.

DESIGN AND SETTING:

Systematic literature review and international web-based survey.

PARTICIPANTS:

More than 300 physicians from 62 countries.

INTERVENTIONS:

Several databases, including MEDLINE/PubMed, were searched with no time limits (updated February 14, 2012) to identify all the drugs/techniques/strategies that fulfilled all the following criteria: (a) published in a peer-reviewed journal, (b) dealing with critically ill adult patients with or at risk for acute kidney injury, and (c) reporting a statistically significant reduction or increase in mortality.

MEASUREMENTS AND MAIN RESULTS:

Of the 18 identified interventions, 15 reduced mortality and 3 increased mortality. Perioperative hemodynamic optimization, albumin in cirrhotic patients, terlipressin for hepatorenal syndrome type 1, human immunoglobulin, peri-angiography hemofiltration, fenoldopam, plasma exchange in multiple-myeloma-associated AKI, increased intensity of renal replacement therapy (RRT), CVVH in severely burned patients, vasopressin in septic shock, furosemide by continuous infusion, citrate in continuous RRT, N-acetylcysteine, continuous and early RRT might reduce mortality in critically ill patients with or at risk for AKI; positive fluid balance, hydroxyethyl starch and loop diuretics might increase mortality in critically ill patients with or at risk for AKI. Web-based opinion differed from consensus opinion for 30% of interventions and self-reported practice for 3 interventions.

CONCLUSION:

The authors identified all interventions with at least 1 study suggesting a significant effect on mortality in patients with or at risk of AKI and found that there is discordance between participant stated beliefs and actual practice regarding these topics.

• Authors: Giovanni Landoni, Tiziana Bove, Andrea Székely, Marco Comis, Reitze N Rodseth, Daniela Pasero, Martin Ponschab, Marta Mucchetti, Tiziana Bove, Maria L Azzolini, Fabio Caramelli, Gianluca Paternoster, Giovanni Pala, Luca Cabrini, Daniele Amitrano, Giovanni Borghi, Antonella Capasso, Claudia Cariello, Anna Carpanese, Paolo Feltracco, Leonardo Gottin, Rosetta Lobreglio, Lorenzo Mattioli, Fabrizio Monaco, Francesco Morgese, Mario Musu, Laura Pasin, Antonio Pisano, Agostino Roasio, Gianluca Russo, Giorgio Slaviero, Nicola Villari, Annalisa Vittorio, Mariachiara Zucchetti, Fabio Guarracino, Andrea Morelli, Vincenzo De Santis, Paolo A Del Sarto, Antonio Corcione, Marco Ranieri, Gabriele Finco, Alberto Zangrillo, Rinaldo Bellomo
• Journal: Journal of cardiothoracic and vascular anesthesia (J Cardiothorac Vasc Anesth) Vol. 27 Issue 6 Pg. 1384-98 (Dec 2013) ISSN: 1532-8422 [Electronic] United States
• PMID: 24103711 (Publication Type: Journal Article, Meta-Analysis, Review, Systematic Review)
• Copyright: Copyright © 2013 Elsevier Inc. All rights reserved.

Topics

• Acute Kidney Injury (mortality, prevention & control, therapy)
• Comorbidity
• Health Care Surveys
• Hemodynamics
• Humans
• Internet
• Monitoring, Intraoperative
• Perioperative Care