SYSTEMATIC REVIEW article
Front. Surg.
Sec. Cardiovascular Surgery
Volume 12 - 2025 | doi: 10.3389/fsurg.2025.1508487
Intra and Post-Operative Fluid Balance and Acute Kidney Injury after Cardiac Surgery: A Systematic Review and Meta-Analysis Authors
Provisionally accepted
- 1Shahid Beheshti University of Medical Sciences, Tehran, Iran
- 2School of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Mazandaran, Iran
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Background: Despite convincing evidence regarding the relationship between fluid balance and the occurrence of acute kidney injury in primary studies, no review studies have investigated the magnitude, direction, and challenges of this relationship. This study aimed at evaluating the relationship between intra and post-operative fluid balance and acute kidney injury after cardiac surgery.Method: Five electronic databases were searched from inception to March 1, 2024: PubMed, Embase, Cochrane Library, Web of Science (WoS), and Scopus. No date or language limits were applied. Also, this systematic study used the Newcastle-Ottawa Quality Assessment Form to assess the risk of bias. Due to the significant methodological heterogeneity, a combination of metaanalysis and narrative synthesis was used to combine the results of primary studies.Results: A total of 13678 participants were recruited in 14 included studies. Eleven studies were narratively synthesized. Five other studies were recruited in the meta-analysis. The results of narrative synthesis in two of three studies showed that post-operative fluid balance was higher in acute kidney injury groups than in non-acute kidney injury groups. Also, four studies showed that acute kidney injury incidence was higher in groups with higher post-operative fluid balance.Regarding intra-operative fluid balance two studies showed conflicted results. In the metaanalysis, the pooled difference in incidence rate was calculated as 18.2% (95% CI= 5% and 31.4%) (I 2 = 81.73%), showing a significantly higher incidence rate in the positive fluid balance group than negative fluid balance. Also, fluid balance differences between the acute kidney injury progression and non-progression groups were 2.33 ml/kg (95% CI= 0.07 to 4.58) (I 2 = 95.19%). The acute kidney injury progression group showed significantly higher fluid balance.The results of our study suggest that positive fluid balance after cardiac surgery can be associated with acute renal failure. However, this study possess substantial limitations and to ensure certainty in the findings, additional primary studies are required to conduct a comprehensive meta-analysis.
Keywords: Fluid balance, Acute Kidney Injury, cardiac surgery, fluid overload, Fluid accumulation
Received: 09 Oct 2024; Accepted: 21 Apr 2025.
Copyright: © 2025 Sarmadi, Zare-Kaseb, Nazari and Emami Zeydi. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Sogand Sarmadi, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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