Comparison of renal outcomes in off‐pump versus on‐pump coronary artery bypass grafting: A systematic review and meta‐analysis of randomized controlled trials. (October 2015)

• Record Type: Journal Article
• Authors: Cheungpasitporn, Wisit; Thongprayoon, Charat; Kittanamongkolchai, Wonngarm; Srivali, Narat; O'Corragain, Oisin A; Edmonds, Peter J; Ratanapo, Supawat; Spanuchart, Ittikorn; Erickson, Stephen B
• Is Part Of: Nephrology. Volume 20:Number 10(2015)
• Page Start: 727
• Page End: 735
• Publication Date: 2015-10
• Subjects: acute kidney injury -- dialysis -- mortality -- off‐pump coronary artery bypass -- renal outcomes; Nephrology -- Periodicals; Kidneys -- Diseases -- Periodicals; Nephrologists -- Periodicals; 616.61; 616.61
• DOI: 10.1111/nep.12506
• Languages: English
• ISSNs: 1320-5358

Abstract

Abstract: Aim: 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. Methods: 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 andclinicaltrials.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. Results: 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. Conclusions: 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. Summary at a Glance: The authors performed a meta‐analysis of RCTs studying the impact of off‐pump CABG on the incidence of AKI. The analysis favours the use of off‐pump on the outcome of AKI despite lacking an impact on the need for dialysis or mortality.