Cheungpasitporn Wisit, Thongprayoon Charat, Kittanamongkolchai Wonngarm, Srivali Narat, O'Corragain Oisin A, Edmonds Peter J, Ratanapo Supawat, Spanuchart Ittikorn, Erickson Stephen B
Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA.
Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Nephrology (Carlton). 2015 Oct;20(10):727-735. doi: 10.1111/nep.12506.
The objective of this meta-analysis was to compare the effects of off-pump and on-pump coronary artery bypass grafting (CABG) on acute kidney injury (AKI) and the need of dialysis after surgery.
Comprehensive literature searches for randomized controlled trials (RCTs) of CABG with on-pump and off-pump was performed using MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials Systematic Reviews and clinicaltrials.gov from inception through September 2014. Primary outcomes were the incidence of AKI and the need of dialysis. Mortality was assessed among the studies that reported renal outcomes. Pooled risk ratios (RRs) and 95% confidence interval (CI) were calculated using a random-effect, generic inverse variance method.
Thirty-three RCTs with 17 322 patients were enrolled in our study. Patients in the off-pump CABG group had overall lower incidence of AKI (19.1%) compared with the on-pump CABG group (22.2%). There was a protective effect of off-pump CABG on the incidence of AKI compared with the on-pump CABG group (RR: 0.87; 95% CI: 0.77-0.98). However, there was no significant difference in the need for dialysis in the off-pump group compared with the on-pump group (RR: 0.84; 95% CI 0.63-1.13). Within the selected trials, post hoc analysis assessing the mortality outcome demonstrated a pooled RR of 0.97 (95% CI, 0.77-1.23) in off-pump versus on-pump CABGs.
Our study demonstrates a beneficial effect of off-pump CABG on the incidence of AKI. However, our meta-analysis does not show benefits of the need of dialysis or survival among patients undergoing off-pump CABG.
本荟萃分析的目的是比较非体外循环冠状动脉旁路移植术（CABG）与体外循环冠状动脉旁路移植术对急性肾损伤（AKI）及术后透析需求的影响。
使用MEDLINE、EMBASE、Cochrane系统评价数据库、Cochrane对照试验中央注册库系统评价和clinicaltrials.gov，对自起始至2014年9月的关于体外循环和非体外循环CABG的随机对照试验（RCT）进行全面文献检索。主要结局为AKI的发生率和透析需求。在报告了肾脏结局的研究中评估死亡率。采用随机效应、通用逆方差法计算合并风险比（RRs）和95%置信区间（CI）。
我们的研究纳入了33项RCT，共17322例患者。非体外循环CABG组患者的AKI总体发生率（19.1%）低于体外循环CABG组（22.2%）。与体外循环CABG组相比，非体外循环CABG对AKI发生率有保护作用（RR：0.87；95%CI：0.77-0.98）。然而，非体外循环组与体外循环组在透析需求方面无显著差异（RR：0.84；95%CI：0.63-1.13）。在所选试验中，评估死亡率结局的事后分析显示，非体外循环CABG与体外循环CABG相比，合并RR为0.97（95%CI，0.77-1.23）。
我们的研究表明非体外循环CABG对AKI发生率有有益影响。然而，我们的荟萃分析未显示非体外循环CABG患者在透析需求或生存方面有获益。
