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2016 ; 6
(2
): 116-28
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Acute Kidney Injury in Cardiorenal Syndrome Type 1 Patients: A Systematic Review
and Meta-Analysis
#MMPMID26989397
Vandenberghe W
; Gevaert S
; Kellum JA
; Bagshaw SM
; Peperstraete H
; Herck I
; Decruyenaere J
; Hoste EA
Cardiorenal Med
2016[Feb]; 6
(2
): 116-28
PMID26989397
show ga
BACKGROUND: We evaluated the epidemiology and outcome of acute kidney injury
(AKI) in patients with cardiorenal syndrome type 1 (CRS-1) and its subgroups:
acute heart failure (AHF), acute coronary syndrome (ACS) and after cardiac
surgery (CS). SUMMARY: We performed a systematic review and meta-analysis. CRS-1
was defined by AKI (based on RIFLE, AKIN and KDIGO), worsening renal failure
(WRF) and renal replacement therapy (RRT). We investigated the three most common
clinical causes of CRS-1: AHF, ACS and CS. Out of 332 potential papers, 64 were
eligible - with AKI used in 41 studies, WRF in 25 and RRT in 20. The occurrence
rate of CRS-1, defined by AKI, WRF and RRT, was 25.4, 22.4 and 2.6%,
respectively. AHF patients had a higher occurrence rate of CRS-1 compared to ACS
and CS patients (AKI: 47.4 vs. 14.9 vs. 22.1%), but RRT was evenly distributed
among the types of acute cardiac disease. AKI was associated with an increased
mortality rate (risk ratio = 5.14, 95% CI 3.81-6.94; 24 studies and 35,227
patients), a longer length of stay in the intensive care unit [LOSICU] (median
duration = 1.37 days, 95% CI 0.41-2.33; 9 studies and 10,758 patients) and a
longer LOS in hospital [LOShosp] (median duration = 3.94 days, 95% CI 1.74-6.15;
8 studies and 35,227 patients). Increasing AKI severity was associated with worse
outcomes. The impact of CRS-1 defined by AKI on mortality was greatest in CS
patients. RRT had an even greater impact compared to AKI (mortality risk ratio =
9.2, median duration of LOSICU = 10.6 days and that of LOShosp = 20.2 days). KEY
MESSAGES: Of all included patients, almost one quarter developed AKI and
approximately 3% needed RRT. AHF patients experienced the highest occurrence rate
of AKI, but the impact on mortality was greatest in CS patients.