Nephroprotective effects of hyperbaric oxygen therapy in murine models of acute kidney injury: A systematic review and meta-analysis

• Published in: Life sciences (1973) Vol. 357; p. 123098
• Main Authors: Canêdo, Vítor Silveira Reis, de Moraes, Marcus Vinícius, Abreu, Bento João, Silva, Flávio Santos
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 15.11.2024
• Subjects: acute kidney injury; Acute Kidney Injury - blood; Acute Kidney Injury - therapy; Acute renal failure; Animal models; Animals; Azotemia; biomarkers; blood serum; Blood Urea Nitrogen; confidence interval; Creatinine; Creatinine - blood; Disease Models, Animal; histology; Hyperbaric oxygenation; Hyperbaric Oxygenation - methods; Kidney - pathology; meta-analysis; Mice; nephroprotective effect; Nephrotoxicity; oxygen; renal function; statistical models; systematic review; therapeutics; toxicity; urea nitrogen; uremia; Creatinine; Hyperbaric oxygenation; Animal models; Nephrotoxicity; Acute renal failure; Azotemia
• ISSN: 0024-3205; 1879-0631; 1879-0631
• DOI: 10.1016/j.lfs.2024.123098

Acute kidney injury (AKI) is a life-threatening condition marked by sudden kidney function loss and azotemia. While its management is limited to supportive care, the effects of hyperbaric oxygen therapy (HBO) on AKI remain a subject of conflicting animal research. This study aimed to systematically review and meta-analyze HBO's effects on renal function biomarkers serum creatinine (SCr) and blood urea nitrogen (BUN) in murine AKI models, also exploring tissue-level nephroprotection. The PUBMED, SciELO, and LILACS databases were searched until September 5, 2024. Effect sizes of HBO on SCr and BUN levels were expressed as standardized mean difference (SMD) alongside 95 % confidence interval (CI), calculated by random-effects model. Extracted data also included murine specie/strain, HBO parameters, AKI induction method (toxic, ischemic, others), and histological findings. Study quality and publication bias were respectively assessed using the CAMARADES checklist and Egger's test. This review adhered to PRISMA guidelines and was registered in PROSPERO (CRD42022369804). Data synthesis from 21 studies demonstrates that HBO effectively reduces azotemia in AKI-affected animals (SCr's SMD = −1.69, 95 % CI = −2.38 to −0.99, P < 0.001; BUN's SMD = −1.51, 95 % CI = −2.32 to −0.71, P < 0.001) while mitigating histological damage. Subgroup analyses indicate that HBO particularly benefits ischemic and other AKI types (P < 0.05). In contrast, data from toxic AKI models were inconclusive due to insufficient statistical power (P > 0.05, 1-β < 30 %). This meta-analysis provides compelling evidence supporting the adjunctive use of HBO in AKI management. [Display omitted] •HBO significantly reduced azotemia in AKI animals by 27–30 % vs. untreated controls•HBO appeared not to benefit toxic AKI as it did for ischemic and other models•Reduction of azotemia by HBO was invariably linked to structural nephroprotection