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

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acute kidney injury 8 nephrologydiseases

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acute kidney injury 982 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.ResultsTen RCTs involving 1363 participants were included.
acute kidney injury 3848 without ARDS. Therefore, we conducted this systematic review and meta-analysis to ascertain the risk of acute kidney injury (AKI) in iNO therapy and to investigate whether the risk varies among different patient populations.Materials
acute kidney injury 9671 trialsStudy (year)CountryStudy populationProtocol of iNO therapyMean iNO dosageAge, yearsDefinition of acute kidney injury (AKI)Number of AKI/number of casesiNOControlDellinger (1998) [[12]]USAARDS1.25, 5.0, 20.0, 40.0, or
acute kidney injury 10970 phase80 ppm56Renal dysfunction3/407/40Trzeciak (2014) [[27]]USASepsis40 ppm for 6 h40 ppm59RRT2/261/23AKI, acute kidney injury ; ARDS, acute respiratory distress syndrome; iNO, inhaled nitric oxide; FiO2: inspired oxygen fraction;
acute kidney injury 12360 I2 = 0%). The statistical heterogeneity was low among the analyses.Figure 2Forest plot for the risk of acute kidney injury . iNO, inhaled nitric oxide.For the endpoint of AKI requiring renal replacement therapy (Figure 3),
acute kidney injury 15121 18.26)0.63Not applicablePediatric hypoxemic respiratory failure1 (80)0.67 (0.10 to 4.49)0.68Not applicableAKI, acute kidney injury ; ARDS, acute respiratory distress syndrome.To test the dose-response relationship between iNO and the
acute kidney injury 16373 size (P = 0.10).Table 4Dose-response relationship between inhaled nitric oxide and the risk of acute kidney injury Cumulative dose of inhaled nitric oxideNumer of studies (number of patients)Risk ratio of AKI (95% CI)P-value
acute kidney injury 16738 1.81)0.40I2 = 0%[[24],[27],[28]]High5 (1069)1.52 (1.14 to 2.02)0.004I2 = 0%[[12],[20],[21],[23],[26]]AKI, acute kidney injury .Figure 5Bubble plot with fitted meta-regression line depicting the relationship between the risk of

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