Interventions for Protecting Renal Function in the Perioperative Period

Background: A number of methods have been used to try to protect kidney function in patients undergoing surgery. These include the administration of dopamine, diuretics, calcium channel blockers, angiotensin converting enzyme (ACE) inhibitors and hydration fluids. Objectives: For this review, we selected randomized controlled trials, which used different methods to protect renal function during the perioperative period. In examining these trials, we considered outcomes such as renal failure and mortality, as well as changes in the renal function tests, including urine output, creatinine clearance, free water clearance, fractional excretion of sodium and renal plasma flow. Search strategy: We searched the Cochrane Central register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 4, 2004), MEDLINE (1966 to 2004) and EMBASE (1988 to 2004) and hand-searched six journals (British Journal of Anesthesia; Anesthesia & Analgesia; Anesthesiology; Annals of Surgery; Journal of Thoracic and Cardiovascular Surgery and Journal of Vascular Surgery). Selection criteria: We selected all randomized controlled trials in an adult population undergoing surgery in which a treatment measure was used for the purpose of renal protection in the perioperative period. Data collection and analysis: We selected 37 studies for inclusion in this review. As well as analysis of the data from all the studies, we also performed subgroup analysis for type of interventions, types of surgical procedures and those with preexisting renal dysfunction. We undertook sensitivity analysis on studies with high methodological quality. Main results: The review included data from 37 studies, comprising a total of 1227 patients. Of these, 658 received some form of treatment and 569 acted as controls. The interventions were mostly using different drugs such as dopamine, diuretics, calcium channel blockers, ACE inhibitors, or selected hydration fluids. The results indicated that certain interventions showed some benefits, but all the results suffered from significant heterogeneity. Hence we can draw no conclusions about the effectiveness of these interventions in protecting the kidneys during surgery. Reviewers’ conclusions: There is no reliable evidence from available literature to suggest that interventions during surgery can protect the kidneys from damage. However, there is a need for more studies of high methodological quality. One particular area for further studies may be on patients with preexisting renal dysfunction undergoing surgery. Citation: Zacharias M, Gilmore ICS, Herbison GP, Sivalingam P, Walker RJ. Interventions for protecting renal function in the perioperative period. (Cochrane Review). In: The Cochrane Library, Issue 3, 2005. Chichester, UK: John Wiley & Sons, Ltd. Copyright Cochrane Library, reproduced with permission