Key result
Perioperative nitric oxide cuts AKI risk ~24% in cardiac surgery patients.
Why the study?
Acute kidney injury remains a significant complication after cardiac surgery, and the efficacy of exogenous nitric oxide administration to prevent AKI is conflicting.
Does perioperative nitric oxide administration reduce the incidence of acute kidney injury in patients undergoing cardiac surgery?
Meta-Analysis (n=1,709)
Does perioperative nitric oxide administration reduce the incidence of acute kidney injury in patients undergoing cardiac surgery?
Relative Risk: 0.76 (95% CI 0.61–0.94)
p-value: p=0.01
Perioperative nitric oxide administration significantly reduces the incidence of acute kidney injury and overall mortality in patients undergoing cardiac surgery, although it does not significantly improve resource utilization measures such as length of stay.
Background: Acute kidney injury (AKI) is still a significant and dangerous consequence after heart surgery. During cardiopulmonary bypass, hemolysis causes the endogenous production of nitric oxide (NO) to be scavenged, leading to vasoconstriction and kidney ischemia. Although there is still conflicting clinical evidence, exogenous NO injection has been suggested as a prophylactic measure to restore vascular tone and lessen ischemia-reperfusion harm. Methods: A thorough search for randomized controlled trials (RCTs) assessing NO treatment was conducted across all the databases. The incidence of AKI was the main result. AKI staging, the need for blood transfusions, hospital and intensive care unit length of stay (LOS), death, and the necessity for renal replacement therapy (RRT) were examples of secondary outcomes. Continuous outcomes were represented as mean differences (MD) with 95% CI, whereas binary outcomes were pooled using random-effects models that produced risk ratios (RR). Results: Perioperative nitric oxide (NO) treatment significantly decreased the incidence of acute kidney damage (AKI) in comparison to the control group, according to a pooled analysis of nine randomized controlled trials (N = 1,709) (RR 0.76, 95% CI 0.61–0.94; p = 0.01). All AKI severity stages showed a tendency toward risk reduction, with Stage III showing the strongest trend (RR 0.60, 95% CI 0.27–1.32). However, these subgroup analyses did not individually reach statistical significance. Furthermore, a significant reduction in overall mortality was associated with NO delivery (RR 0.57, 95% CI 0.34–0.98; p = 0.04). However, neither blood transfusion (RR 0.90, 95% CI 0.78–1.04; p = 0.17) nor renal replacement treatment (RR 0.77, 95% CI 0.43–1.36; p = 0.37) showed any appreciable advantages. The length of stay in the hospital (MD -0.09 days, 95% CI -0.46 to 0.29; p = 0.65) and intensive care unit (MD -0.10 days, 95% CI -0.24 to 0.04; p = 0.16) was also not substantially impacted by NO treatment. Conclusion: The favorable effects of nitric oxide on lowering acute renal injury and mortality in patients after heart surgery are supported by this meta-analysis. However, we should interpret its operational utility cautiously due to the lack of a notable improvement in resource utilization outcomes. To determine its effect on hospital length of stay and the necessity for renal replacement treatment, more extensive, carefully planned trials are required
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Khan et al. (2026) conducted a meta-analysis in Patients undergoing cardiac surgery (n=1,709). Nitric oxide (NO) vs. Control group was evaluated on Incidence of acute kidney injury (AKI) (RR 0.76, 95% CI 0.61-0.94, p=0.01). Perioperative nitric oxide treatment significantly decreased the incidence of acute kidney injury in cardiac surgery patients compared to control (RR 0.76; 95% CI 0.61-0.94; p=0.01).
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