Reducing mortality in patients with acute kidney injury: A systematic update

Abstract

Since the first international web-based Consensus Conference on mortality reduction in patients with or at risk for acute kidney injury was held, 13 more papers, dealing with ten interventions, have been published in a peer-reviewed journal showing a statistical significant effect on survival in this subset of patients. Seven interventions increased survival: preoperative renin-angiotensin system inhibitors and aspirin, aprotinin, and sedation with dexmedetomidine in cardiac surgery, continuous renal replacement therapy (CRRT) before and after percutaneous coronary intervention (PCI), angiotensin-converting enzyme inhibitors, and high-volume hemofiltration in severe acute pancreatitis. Three interventions increased mortality: fluid overload, high-volume hydration before PCI, and prophylactic sodium bicarbonate in cardiac surgery. However, the overall quality of these studies was low. Only two interventions (CRRT before PCI and fluid overload) were already included in the Consensus Conference, and the new studies identified may strengthen their role in affecting mortality. The others represent new hints for future research.