Journal Editorial Department, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China.
Department of Anesthesiology and Perioperative Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China.
Ren Fail. 2021 Dec;43(1):281-290. doi: 10.1080/0886022X.2021.1873805.
There are conflicting results as to the effect of inhaled nitric oxide (iNO) therapy on the risk of acute kidney injury (AKI). The aim of this study was to perform a meta-analysis to assess the updated data.
We systematically searched Web of Science, the Cochrane Library, Wanfang, and PubMed for relevant randomized control trials between database inception and 9/07/2020. Relative risks (RRs) with 95% confidence intervals (CIs) predicting the risk of AKI were extracted to obtain summary estimates using fixed-effects models. The Trim and Fill method was used to evaluate the sensitivity of the results and adjust for publication bias in meta-analysis.
15 randomized controlled studies from 14 articles involving 1853 patients were included in the study. Analyzing the eligible studies we found: (1) iNO therapy significantly increased the risk of AKI in acute respiratory distress syndrome patients (RR 1.55, 95% CI 1.15-2.10, = 0.004; for heterogeneity 0%; = 0.649). (2) The use of iNO was associated with reduced AKI risk in patients undergoing cardiac surgery (RR 0.80, 95% CI 0.64-0.99, = 0.037; for heterogeneity 0%; = 0.528). (3) For organ transplantation recipients, there was no effect of iNO administration on the risk of AKI (RR 0.50, 95% CI 0.16-1.56, = 0.233; for heterogeneity 0%; = 0.842). The Trim and Fill analysis showed that the overall effect of this meta-analysis was stable.
The effect of iNO on AKI risk might be disease-specific. Future RCTs with larger patient populations should aim to validate our findings.
关于吸入一氧化氮（iNO）治疗对急性肾损伤（AKI）风险的影响，结果存在争议。本研究的目的是进行荟萃分析以评估最新数据。
我们系统地检索了 Web of Science、Cochrane 图书馆、万方和 PubMed，以获取自数据库建立以来至 2020 年 9 月 7 日的相关随机对照试验。使用固定效应模型提取预测 AKI 风险的相对风险（RR）和 95%置信区间（CI），以获得汇总估计值。使用 Trim and Fill 方法评估结果的敏感性并调整荟萃分析中的发表偏倚。
15 项来自 14 篇文章的随机对照研究共纳入 1853 名患者。分析纳入的研究，我们发现：（1）iNO 治疗可显著增加急性呼吸窘迫综合征患者 AKI 的风险（RR 1.55，95%CI 1.15-2.10，=0.004；异质性为 0%；=0.649）。（2）iNO 的使用与心脏手术患者 AKI 风险降低相关（RR 0.80，95%CI 0.64-0.99，=0.037；异质性为 0%；=0.528）。（3）对于器官移植受者，iNO 给药对 AKI 风险无影响（RR 0.50，95%CI 0.16-1.56，=0.233；异质性为 0%；=0.842）。Trim and Fill 分析表明，本荟萃分析的总体效果稳定。
iNO 对 AKI 风险的影响可能是疾病特异性的。未来应进行更大规模患者人群的 RCT 以验证我们的发现。
