%0 Journal Article
%T Natriuretic Peptides in the Management of Solid Organ Transplantation Associated Acute Kidney Injury: A Systematic Review and Meta-Analysis
%A Sagar U. Nigwekar
%A Hrishikesh Kulkarni
%A Charuhas V. Thakar
%J International Journal of Nephrology
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/949357
%X Randomized controlled trials involving natriuretic peptide administration in solid organ transplantation setting have shown inconsistent effects for renal endpoints. We conducted a systematic review and meta-analysis of these trials to ascertain the role of natriuretic peptides in the management of solid organ transplantation associated acute kidney injury (AKI). MEDLINE, EMBASE, and Google scholar were searched independently by two authors for randomized trials evaluating renal effects of natriuretic peptides in solid organ transplantation settings. Two reviewers independently assessed the studies for eligibility and extracted the relevant data. The pooled estimate showed that natriuretic peptide administration is associated with a reduction in AKI requiring dialysis (odds ratio = 0.50 [0.26¨C0.97]), a statistically nonsignificant trend toward improvement in posttransplant creatinine clearance (weighted mean difference = 5.5£¿mL/min, [£¿1.3 to 12.2£¿mL/min]), and reduction in renal replacement requirement duration (weighted mean difference £¿44.0 hours, [£¿60.5 to £¿27.5 hours]). There were no mortality events and no adverse events related to natriuretic peptides. In conclusion, administration of natriuretic peptides in solid organ transplantation may be associated with significant improvements in renal outcomes. These observations need to be confirmed in an adequately powered, prospective multicenter study. 1. Introduction Acute kidney injury (AKI) is common in hospitalized patients and is associated with significant morbidity and mortality [1, 2]. Despite recent advances, outcomes from AKI have not substantially changed in the last four decades and the incidence of AKI is on the rise [3]. Solid organ transplantation procedures (e.g., liver transplantation, heart transplantation, lung transplantation, and combined solid organ transplantations such as heart-lung transplant) are a recognized cause of AKI and renal transplantation is also frequently associated with AKI [4¨C10]. The incidence of AKI after liver transplantation reportedly ranges from 12% to 67% depending upon the definition used [4, 11]. Dialysis is required in up to 21% of the cases [4], and AKI in this setting is associated with higher mortality [4, 11]. Similarly, the incidence of AKI remains high in immediate postcardiac transplantation setting as up to 1/3rd of patients develop AKI [7]. Postischemic acute tubular necrosis is the most common cause of persistent renal failure (also known as delayed graft function) in the immediate postrenal transplant period and remains a major obstacle for
%U http://www.hindawi.com/journals/ijn/2013/949357/