American journal of kidney diseases : the official journal of the National Kidney Foundation
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Review Meta Analysis
Off-pump coronary artery bypass surgery and acute kidney injury: a meta-analysis of randomized and observational studies.
Acute kidney injury (AKI) after coronary artery bypass grafting (CABG) is associated with significant morbidity and mortality. Controversy exists regarding whether an off-pump technique can reduce post-CABG renal injury. ⋯ Analysis of the current evidence suggests a reduction in AKI using the OPCAB technique; however, studies lack consistency in defining AKI. Available RCTs are underpowered to detect a difference in AKI requiring RRT; evidence from observational studies suggests a reduction in RRT requirement. Future studies should apply a standard definition of AKI and target a high-risk population.
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Meta Analysis Comparative Study
Homocysteine as a risk factor for cardiovascular disease in patients treated by dialysis: a meta-analysis.
In the general population, increased homocysteine concentrations are a risk factor for cardiovascular disease and mortality. However, it is not known whether this also applies to patients with end-stage renal disease. ⋯ Total homocysteine level may be a risk factor for cardiovascular events and total mortality in patients with end-stage renal disease not receiving vitamin supplementation or folic acid food fortification. There may be a potential for reducing cardiovascular disease in this population by folic acid supplementation.
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Review Meta Analysis
Sodium bicarbonate therapy for prevention of contrast-induced nephropathy: a systematic review and meta-analysis.
Optimal hydration measures to prevent contrast-induced nephropathy are controversial. ⋯ Hydration with sodium bicarbonate decreases the incidence of contrast-induced nephropathy in comparison to hydration with normal saline without a significant difference in need for renal replacement therapy and in-hospital mortality. Larger studies analyzing patient-centered outcomes are needed.
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Acute renal failure after major surgery is associated with significant mortality and morbidity that theoretically may be attenuated by N-acetylcysteine. ⋯ There is no current evidence that N-acetylcysteine used perioperatively can alter mortality or renal outcomes when radiocontrast is not used.