by Nedel, Wagner L.;
Rech, Tatiana H.; Ribeiro, Rodrigo A.; Pellegrini, José Augusto S.; Moraes, Rafael
B.
Objectives: To
systematically review the literature and synthesize evidence concerning the
effects of vasopressin and its analogs compared with other vasopressors in
distributive shock, focusing on renal outcomes. Data Sources: We performed a
systematic review in MEDLINE, Embase, Cochrane Central, and Clinicaltrials.gov
databases.
Study Selection:
Randomized clinical trials that compared vasopressin and its analogs with other
vasopressors and reported renal outcomes in adult patients with distributive
shock.
Data Extraction:
Paired reviewers independently screened citations, conducted data extraction
and assessed risk of bias. Three prespecified subgroup analyses were conducted.
Three main outcomes related to acute renal failure were analyzed: the need for
renal replacement therapy, acute kidney injury incidence, and acute kidney
injury-free days. I2 test was used to evaluate heterogeneity between studies. Substantial
heterogeneity was defined as I2 greater than 50%. A random-effects model with
Mantel-Haenszel weighting was used for all analyses. Heterogeneity was explored
using subgroup analysis. The quality of evidence for intervention effects was
summarized using Grading of Recommendations Assessment, Development, and
Evaluation methodology. This study was registered in the PROSPERO database
(CRD42017054324).
Data Synthesis:
Three-thousand twenty-six potentially relevant studies were identified, and 30
articles were reviewed in full. Seventeen studies met the inclusion criteria,
including a total of 2,833 individuals. Of these, 11 studies (2,691
individuals) were suitable for quantitative meta-analysis. Overall, the
evidence was of low to moderate quality. Patients who received vasopressin and
its analogs had a reduced need for renal replacement therapy (odds ratio, 0.59
[0.37–0.92]; p = 0.02; I2 = 49%) and a lower acute kidney injury incidence
(odds ratio, 0.58 [0.37–0.92]; p = 0.02; I2 = 63%). These results should be
interpreted with caution, due to excessive heterogeneity. Acute kidney
injury-free data was not pooled, since the small number of studies and extreme
heterogeneity. Conclusions: In
patients with distributive shock, vasopressin and its analogs use is associated
with a reduced need for renal replacement therapy and lower acute kidney injury
incidence. These results are supported by high risk of bias evidence.
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