Acute kidney injury and cardiac arrest in the modern era: an updated systematic review and meta-analysis

ABSTRACT

Objective: Acute kidney injury (AKI) is associated with higher morbidity and mortality in cardiac arrest (CA). There are limited contemporary data on the incidence and outcomes of AKI in CA.

Methods: We comprehensively searched the databases of MEDLINE, EMBASE, PUBMED, and the Cochrane from inception to November 2020. Observational studies that reported the incidence of AKI in CA survivors were included. Data from each study were combined using the random effects to calculate pooled incidence and risk ratios with 95% confidence intervals (CIs). The primary outcome was short-term mortality and secondary outcomes included long-term mortality, incidence of AKI, and use of renal replacement therapy (RRT). Subgroup and meta-regression analyses were performed to explore heterogeneity.

Main results: A total of 25 observational studies comprising 8,165 patients were included. The incidence of AKI in CA survivors was 40.3% (range 32.9–47.8%). In stage 3 AKI, one-fourth of patients required RRT. AKI was associated with an increased risk of both short-term (OR 2.27 [95% CI 1.74–2.96]; p < 0.001) and long-term mortality (OR 1.51 [95% CI 1.93–3.25]; p < 0.001). Meta-regression and subgroup analyses did not suggest any effect of hypothermia on incidence of AKI.

Conclusion: AKI complicates the care of 40% of CA survivors and is associated with significantly increased short- and long-term mortality.

KEYWORDS:

• Cardiac arrest
• Cardiopulmonary arrest
• Acute kidney injury
• Acute renal failure
• Meta-analysis

ABBREVIATIONS

ACS: Acute coronary syndrome

AKI: Acute kidney injury

AKIN: Acute kidney injury network

CA: Cardiac arrest

CAD: Coronary artery disease

ECMO: Extracorporeal membrane oxygenation

ELAIN: Effect of Early vs Delayed Initiation of Renal Replacement Therapy on Mortality in Critically Ill Patients With Acute Kidney Injury

FDA: Food and drug administration

IABP: Intra-aortic balloon pump

IHCA: In-hospital cardiac arrest

KDIGO: Kidney Disease Improving Global Outcomes

MCS: mechanical circulatory support

OHCA: Out-of-hospital cardiac arrest

PCI: Percutaneous coronary intervention

PVAD: Percutaneous ventricular assisted device

RIFLE: Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease

ROSC: Return of spontaneous circulation

RRT: Renal replacement therapy

TTM: Targeted temperature management

STEMI: ST elevation myocardial infarction

Acknowledgments

None stated

Author contributions

NP: Conception design, data interpretation, draft manuscript, corresponding

WC: Data interpretation, statistical analysis, draft manuscript

RS: Data acquisition, data interpretation

RC: Data acquisition, draft manuscript

CT: Data acquisition, data interpretation

SHP: Data acquisition, draft manuscript

TB: Data acquisition, draft manuscript

MAM: Critical review, article revision

TSR: Critical review, article revision

KK: Critical review, article revision

SV: Conception design, critical review, article revision

Declaration of interest

The authors have no commercial associations that might be a conflict of interest in this article. No funding support for this article.

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

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Additional information

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.