SynthesisCritical care (London, England)2015
Inhaled nitric oxide therapy and risk of renal dysfunction: a systematic review and meta-analysis of randomized trials.
Synthesis in Critical care (London, England), 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 42 papers, 4 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
42 citing papers in PubMed, 4 syntheses or guidelines pooled it, 73 citations in OpenAlex.
- Unraveling the impact of nitric oxide, almitrine, and their combination in COVID-19 (at the edge of sepsis) patients: a systematic review.Frontiers in pharmacology · 2023Pooled it
- Inhaled nitric oxide and acute kidney injury risk: a meta-analysis of randomized controlled trials.Renal failure · 2021Pooled it
- Guidelines on the management of acute respiratory distress syndrome.BMJ open respiratory research · 2019Guideline
- Mechanical Ventilation and Extracorporeal Membrane Oxygena tion in Acute Respiratory Insufficiency.Deutsches Arzteblatt international · 2018Guideline
- Clinical Application of Inhaled Nitric Oxide in Conditions of Excessive Right Heart Load: A Review from Neonatal Pulmonary Hypertension to Perioperative Cardiac Surgery Management.Journal of cardiovascular development and disease · 2026Review
- Inhaled nitric oxide for acute respiratory distress syndrome in adults: a systematic review and meta-analysis.Journal of intensive care · 2026Article
- Decoding lung-kidney interactions in sepsis: an integrated view of molecular mechanisms, pathophysiology, and therapeutic interventions.Frontiers in immunology · 2026Review
- Pulmonary vascular dysfunction in ARDS Pathophysiology and therapeutic implications.Annals of intensive care · 2026Review
- Cardiopulmonary bypass associated acute kidney injury: better understanding and better prevention.Renal failure · 2024Review
- Inhaled NO at a crossroads in cardiac surgery: current need to improve mechanistic understanding, clinical trial design and scientific evidence.Frontiers in cardiovascular medicine · 2024Review
- Inhaled Nitric Oxide in Acute Respiratory Distress Syndrome Subsets: Rationale and Clinical Applications.Journal of aerosol medicine and pulmonary drug delivery · 2023Review
- Use of Aerosolized Prostacyclins in Critically Ill Patients and Association With Clinical Outcomes.Critical care explorations · 2023Article
- Acute Respiratory Distress Syndrome and the Use of Inhaled Pulmonary Vasodilators in the COVID-19 Era: A Narrative Review.Life (Basel, Switzerland) · 2022Review
- Impact of Dexamethasone and Inhaled Nitric Oxide on Severe Acute Kidney Injury in Critically Ill Patients with COVID-19.Journal of clinical medicine · 2022Article
- Acute Respiratory Distress Syndrome in the Perioperative Period of Cardiac Surgery: Predictors, Diagnosis, Prognosis, Management Options, and Future Directions.Journal of cardiothoracic and vascular anesthesia · 2022Review
- Nitric oxide: Clinical applications in critically ill patients.Nitric oxide : biology and chemistry · 2022Review
- Therapeutic Effects of Inhaled Nitric Oxide Therapy in COVID-19 Patients.Biomedicines · 2022Review
- Nitric oxide signalling in kidney regulation and cardiometabolic health.Nature reviews. Nephrology · 2021Review
- Ten golden rules for individualized mechanical ventilation in acute respiratory distress syndrome.Journal of intensive medicine · 2021Review
- Use of Almitrine and Inhaled Nitric Oxide in ARDS Due to COVID-19.Frontiers in medicine · 2021Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionInhaled 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.
methodsA 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.
resultsTen 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 = 0.02). 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 = 0.004), 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 = 0.005) but not in those without (RR, 0.90, 95%CI, 0.49 to 1.67, p = 0.75).
conclusionsThe 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.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.