Evidence map›Paper›PMID 28389482›Full record

SynthesisBMJ open2017

What are the risks and benefits of temporarily discontinuing medications to prevent acute kidney injury? A systematic review and meta-analysis.

Penny Whiting, Andrew Morden, Laurie A Tomlinson, Fergus Caskey, Thomas Blakeman, Charles Tomson, Tracey Stone, Alison Richards, Jelena Savović, Jeremy Horwood

Open access · goldAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMJ open, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 46 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
46citing papers in PubMed, 2 pooled it
6.6field-weighted citation impact, top 2% of its field
1 · What the graph read from 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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

46 citing papers in PubMed, 2 syntheses or guidelines pooled it, 93 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 5 institutions in 1 country.

Penny WhitingThe National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
Andrew MordenThe National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
Laurie A TomlinsonUK Renal Registry, Bristol, UK.
Fergus CaskeySchool of Social and Community Medicine, University of Bristol, Bristol, UK.
Thomas BlakemanCentre for Primary Care, Institute of Population Health, The University of Manchester, Manchester, UK.
Charles TomsonDepartment of Renal Medicine, Freeman Hospital, Newcastle Upon Tyne Hospitals Foundation Trust, Tyne and Wear, UK.
Tracey StoneThe National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
Alison RichardsThe National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
Jelena SavovićThe National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
Jeremy HorwoodThe National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
University Hospitals Bristol NHS Foundation Trust · GBUniversity of Bristol · GBNational Institute for Health Research · GBFreeman Hospital · GBRenal Association · GB

Funding

Wellcome TrustWellcome Trust 101143/Z/13/Z
6 · The paper itself

Abstract

objectivesTo summarise evidence on temporary discontinuation of medications to prevent acute kidney injury (AKI).

designSystematic review and meta-analysis of randomised and non-randomised studies.

participantsAdults taking diuretics, ACE inhibitors (ACEI), angiotensin receptor blockers (ARB), direct renin inhibitors, non-steroidal anti-inflammatories, metformin or sulfonylureas, experiencing intercurrent illnesses, radiological or surgical procedures.

interventionsTemporary discontinuation of any of the medications of interest. PRIMARY AND SECONDARY OUTCOME MEASURES: Risk of AKI. Secondary outcome measures were estimated glomerular filtration rate and creatinine post-AKI, urea, systolic and diastolic blood pressure, death, clinical outcomes and biomarkers.

results6 studies were included (1663 participants), 3 randomised controlled trials (RCTs) and 3 prospective cohort studies. The mean age ranged from 65 to 73 years, and the proportion of women ranged from 31% to 52%. All studies were in hospital settings; 5 evaluated discontinuation of medication prior to coronary angiography and 1 prior to cardiac surgery. 5 studies evaluated discontinuation of ACEI and ARBs and 1 small cohort study looked at discontinuation of non-steroidal anti-inflammatory drugs. No studies evaluated discontinuation of medication in the community following an acute intercurrent illness. There was an increased risk of AKI of around 15% in those in whom medication was continued compared with those in whom it was discontinued (relative risk (RR) 1.17, 95% CI 0.99 to 1.38; 5 studies). When only results from RCTs were pooled, the increase in risk was almost 50% (RR 1.48, 95% CI 0.84 to 2.60; 3 RCTs), but the CI was wider. There was no difference between groups for any secondary outcomes.

conclusionsThere is low-quality evidence that withdrawal of ACEI/ARBs prior to coronary angiography and cardiac surgery may reduce the incidence of AKI. There is no evidence of the impact of drug cessation interventions on AKI incidence during intercurrent illness in primary or secondary care. TRIAL REGISTRATION NUMBER: PROSPERO CRD42015023210.

Indexed as

DeprescriptionsAcute Kidney InjuryAngiotensin-Converting Enzyme InhibitorsAngiotensin Receptor AntagonistsAnti-Inflammatory Agents, Non-SteroidalCreatinineDiureticsGlomerular Filtration RateHumansHypoglycemic AgentsMetforminRenin InhibitorsRisk AssessmentSulfonylurea CompoundsAngiotensin-Converting Enzyme InhibitorsAngiotensin Receptor AntagonistsAnti-Inflammatory Agents, Non-SteroidalCreatinineDiureticsHypoglycemic AgentsMetforminRenin InhibitorsSulfonylurea CompoundsAcute kidney injuryAngiotensin-converting enzyme inhibitorsAngiotensin receptor blockersMedication discontinuationNSAIDsSick day rules

Identifiers

PMID28389482
PMCPMC5541442
OpenAlexW2604467988

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

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.