| Objective:To evaluate the impact of goal-directed fluid therapy(GDFT)on renal function in terms of acute kidney injury(AKI)incidence and renal replacement therapy(RRT)support in critically ill patients.Methods:We searched MEDLINE via Pub Med,EMBASE,CENTRAL and CBM dated up to January 12,2021.No language restrictions were applied.Studies comparing the effect of GDFT with usual care on renal function in critical ill patients were included.GDFT was defined as intervention based on hemodynamic and oxygen delivery parameters.Two authors independently assessed the eligibility and quality of the trials and extracted data.Results:A total of 12 studies with 7719 patients were included.GDFT significantly reduced the incidence of AKI in critical ill patients(OR 0.63,95%CI 0.43 to 0.92,P=0.02),with high heterogeneity(I~2=74%).Sensitivity analysis lowered heterogeneity(I~2=13%)and did not noticeably change this result.Subgroup analyses showed that both in surgery and non-surgery patients,GDFT was associated with a reduction of AKI incidence.And GDFT aimed at dynamic indicators is better than EGDT protocol for AKI prevention.However,neither RRT rate(OR 0.81,95%CI 0.59 to 1.13,P=0.22;I~2=57%)nor RRT duration(MD 1.01,95%CI-2.52 to 4.53,P=0.57;I~2=63%)was different between the groups.Although GDFT increased fluid administration in the first 12 hours(MD 353.24,95%CI 271.42 to 435.05,P=0.08;I~2=79%),there was no difference between the groups in the initial 72 hours(MD190.41,95%CI-19.34 to 400.16,P=0.08;I~2=12%).Moreover,GDFT was associated with more vasopressor support,but had no effect on duration of vasopressor,duration of mechanical ventilation,or length of ICU stay.Conclusions:This meta-analysis suggests that GDFT can reduce AKI incidence in critical illness,but has no effect on RRT support.GDFT aimed at dynamic indicators is more effective for AKI prevention. |
