Inhaled nitric oxide therapy and risk of renal dysfunction: a systematic review and meta-analysis of randomized trials

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• 作者：Sheng-Yuan Ruan (1) (2)
  Tao-Min Huang (1)
  Hon-Yen Wu (1) (3)
  Huey-Dong Wu (2)
  Chong-Jen Yu (2)
  Mei-Shu Lai (1)
  
  1. Institute of Epidemiology and Preventive Medicine ; National Taiwan University ; No.17 Xu-Zhou Road ; Taipei ; 10020 ; Taiwan
  2. Division of Pulmonary and Critical Care Medicine ; Department of Internal Medicine ; National Taiwan University Hospital ; Taipei ; Taiwan
  3. Department of Internal Medicine ; Far Eastern Memorial Hospital ; New Taipei City ; Taiwan
  
• 刊名：Critical Care
• 出版年：2015
• 出版时间：December 2015
• 年：2015
• 卷：19
• 期：1
• 全文大小：560 KB
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• 刊物主题：Intensive / Critical Care Medicine; Emergency Medicine;
• 出版者：BioMed Central
• ISSN：1364-8535

文摘

Introduction Inhaled nitric oxide (iNO) is an important therapy for acute respiratory distress syndrome (ARDS), pulmonary hypertension and pediatric hypoxemic respiratory failure. Safety concerns regarding iNO and renal dysfunction have been reported; however, there are currently no systematic reviews on this issue. Our objective was to evaluate published randomized controlled trials (RCTs) to ascertain the risk of renal dysfunction associated with iNO therapy in patients with and without ARDS. Methods A systematic review of databases was performed to identify RCTs which compared iNO with controls up to September 2014. Effect estimates for risk ratio (RR) of acute kidney injury (AKI) were pooled using a random-effects model. Results Ten RCTs involving 1363 participants were included. Inhaled nitric oxide significantly increased the risk of AKI compared with controls (RR, 1.4, 95%CI, 1.06 to 1.83, p鈥?鈥?.02). In the stratified analysis, a high cumulative-dose of iNO significantly increased the risk of AKI (RR, 1.52, 95%CI, 1.14 to 2.02, p鈥?鈥?.004), whereas medium and low cumulative-doses did not (RR, 0.64, 95%CI, 0.23 to 1.81 and RR, 0.56, 95%CI, 0.11 to 2.86 respectively). In subgroup analysis by study population, an increased risk of AKI was observed in patients with ARDS (RR, 1.55, 95%CI, 1.15 to 2.09, p鈥?鈥?.005) but not in those without (RR, 0.90, 95%CI, 0.49 to 1.67, p鈥?鈥?.75). Conclusions The available data show that iNO therapy may increase the risk of renal dysfunction, especially with prolonged use and in patients with ARDS. The risk in pediatric population is unknown owing to limited data. We suggest monitoring renal function during iNO therapy, and that future trials of iNO should evaluate renal safety.