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The effect of the time interval between coronary angiography and on-pump cardiac surgery on risk of postoperative acute kidney injury: a meta-analysis.

Hu Y, Li Z, Chen J, Shen C, Song Y, Zhong Q - J Cardiothorac Surg (2013)

Bottom Line: Study-specific estimates were combined with inverse variance-weighted averages of logarithmic odds ratios (ORs) in fixed-effects models.From 8 studies involving 11542 persons, the pooled OR of AKI associated with an interval of 1 day or less between CAG and surgery was 1.21 (95% confidence interval (CI), 1.04 to 1.39) relative to an interval of more than 1 day.From 4 studies involving 5420 persons in the cardiopulmonary-bypass subgroup, the pooled OR of AKI associated with an interval of 3 days or less between CAG and surgery was 1.25 (95% CI, 1.07 to 1.43) relative to an interval of more than 3 days.

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ABSTRACT

Background: Reports of the association between the time interval from coronary angiography (CAG) to cardiac surgery and risk of postoperative acute kidney injury (AKI) are controversial. We attempted to examine this association by conducting a meta-analysis.

Methods: We searched the Pubmed, MEDLINE, EMBASE, Web of Science databases, and the Cochrane Library from January 1966 to March 2013. A meta-analysis of studies reporting data for 1-day and 3-day time intervals between CAG and cardiac surgery was conducted after evaluation of heterogeneity and publication bias. Study-specific estimates were combined with inverse variance-weighted averages of logarithmic odds ratios (ORs) in fixed-effects models.

Results: From 8 studies involving 11542 persons, the pooled OR of AKI associated with an interval of 1 day or less between CAG and surgery was 1.21 (95% confidence interval (CI), 1.04 to 1.39) relative to an interval of more than 1 day. From 4 studies involving 5420 persons in the cardiopulmonary-bypass subgroup, the pooled OR of AKI associated with an interval of 3 days or less between CAG and surgery was 1.25 (95% CI, 1.07 to 1.43) relative to an interval of more than 3 days. The adjusted OR of the study in the cardiopulmonary bypass/ deep hypothermic circulatory arrest subgroup was 0.35 (95% CI, 0.17 to 0.73).

Conclusions: A time interval of 1 day or less between CAG and on-pump cardiac surgery was significantly associated with increased risk of AKI. A delay of on-pump cardiac surgery until 24 hours after CAG can potentially decrease postoperative AKI.

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Flow diagram of study selection for the meta-analysis. AKI = acute kidney injury; CAG = coronary angiography.
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Figure 1: Flow diagram of study selection for the meta-analysis. AKI = acute kidney injury; CAG = coronary angiography.

Mentions: As outlined in Figure 1, we identified 9 studies for the meta-analysis, including 5 cohort studies and 4 case-control studies. Detailed characteristics of the studies are listed in Table 1. Among the 9 studies, 5 studies used the AKI Network definition of AKI [19], an absolute increase in serum creatinine to ≥0.3 mg/dL, or a relative increase of ≥50% from the baseline value within 48 h after surgery, or a requirement for postoperative dialysis; 3 studies defined AKI on the basis of the RIFLE (Risk, Injury, Failure, Loss, End-stage renal disease) criteria [20] (“R” stage: plasma creatinine levels ≥1.5 × baseline; “I” stage: plasma creatinine levels ≥2.0 × baseline); and 1 study defined AKI as a greater than 25% rise in serum creatinine by the third postoperative day or as renal dysfunction that required the initiation of dialysis. Quality assessment of all studies was performed by using the NOS method (Table 2). The assessments ranged from a star rating of 6 to 8 (mean star rating, 7) with a higher value indicating better methodology.


The effect of the time interval between coronary angiography and on-pump cardiac surgery on risk of postoperative acute kidney injury: a meta-analysis.

Hu Y, Li Z, Chen J, Shen C, Song Y, Zhong Q - J Cardiothorac Surg (2013)

Flow diagram of study selection for the meta-analysis. AKI = acute kidney injury; CAG = coronary angiography.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3750660&req=5

Figure 1: Flow diagram of study selection for the meta-analysis. AKI = acute kidney injury; CAG = coronary angiography.
Mentions: As outlined in Figure 1, we identified 9 studies for the meta-analysis, including 5 cohort studies and 4 case-control studies. Detailed characteristics of the studies are listed in Table 1. Among the 9 studies, 5 studies used the AKI Network definition of AKI [19], an absolute increase in serum creatinine to ≥0.3 mg/dL, or a relative increase of ≥50% from the baseline value within 48 h after surgery, or a requirement for postoperative dialysis; 3 studies defined AKI on the basis of the RIFLE (Risk, Injury, Failure, Loss, End-stage renal disease) criteria [20] (“R” stage: plasma creatinine levels ≥1.5 × baseline; “I” stage: plasma creatinine levels ≥2.0 × baseline); and 1 study defined AKI as a greater than 25% rise in serum creatinine by the third postoperative day or as renal dysfunction that required the initiation of dialysis. Quality assessment of all studies was performed by using the NOS method (Table 2). The assessments ranged from a star rating of 6 to 8 (mean star rating, 7) with a higher value indicating better methodology.

Bottom Line: Study-specific estimates were combined with inverse variance-weighted averages of logarithmic odds ratios (ORs) in fixed-effects models.From 8 studies involving 11542 persons, the pooled OR of AKI associated with an interval of 1 day or less between CAG and surgery was 1.21 (95% confidence interval (CI), 1.04 to 1.39) relative to an interval of more than 1 day.From 4 studies involving 5420 persons in the cardiopulmonary-bypass subgroup, the pooled OR of AKI associated with an interval of 3 days or less between CAG and surgery was 1.25 (95% CI, 1.07 to 1.43) relative to an interval of more than 3 days.

View Article: PubMed Central - HTML - PubMed

ABSTRACT

Background: Reports of the association between the time interval from coronary angiography (CAG) to cardiac surgery and risk of postoperative acute kidney injury (AKI) are controversial. We attempted to examine this association by conducting a meta-analysis.

Methods: We searched the Pubmed, MEDLINE, EMBASE, Web of Science databases, and the Cochrane Library from January 1966 to March 2013. A meta-analysis of studies reporting data for 1-day and 3-day time intervals between CAG and cardiac surgery was conducted after evaluation of heterogeneity and publication bias. Study-specific estimates were combined with inverse variance-weighted averages of logarithmic odds ratios (ORs) in fixed-effects models.

Results: From 8 studies involving 11542 persons, the pooled OR of AKI associated with an interval of 1 day or less between CAG and surgery was 1.21 (95% confidence interval (CI), 1.04 to 1.39) relative to an interval of more than 1 day. From 4 studies involving 5420 persons in the cardiopulmonary-bypass subgroup, the pooled OR of AKI associated with an interval of 3 days or less between CAG and surgery was 1.25 (95% CI, 1.07 to 1.43) relative to an interval of more than 3 days. The adjusted OR of the study in the cardiopulmonary bypass/ deep hypothermic circulatory arrest subgroup was 0.35 (95% CI, 0.17 to 0.73).

Conclusions: A time interval of 1 day or less between CAG and on-pump cardiac surgery was significantly associated with increased risk of AKI. A delay of on-pump cardiac surgery until 24 hours after CAG can potentially decrease postoperative AKI.

Show MeSH
Related in: MedlinePlus