Acute Kidney Injury after Cardiac Surgery: Prediction, Prevention, and Management

Acute kidney injury (AKI) is a common complication in cardiac surgery patients, with a reported incidence of 20 to 30%. The development of AKI is associated with worse short- and long-term mortality, and longer hospital length of stay. The pathogenesis of cardiac surgery-associated AKI is poorly und...

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Bibliographic Details
Published in:Anesthesiology (Philadelphia) 2023-12, Vol.139 (6), p.880-898
Main Authors: Cheruku, Sreekanth R, Raphael, Jacob, Neyra, Javier A, Fox, Amanda A
Format: Article
Language:English
Subjects:
Acute Kidney Injury - diagnosis
Biomarkers
Cardiac Surgical Procedures - adverse effects
Comorbidity
Humans
Postoperative Complications - diagnosis
Risk Factors
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Summary:Acute kidney injury (AKI) is a common complication in cardiac surgery patients, with a reported incidence of 20 to 30%. The development of AKI is associated with worse short- and long-term mortality, and longer hospital length of stay. The pathogenesis of cardiac surgery-associated AKI is poorly understood but likely involves an interplay between preoperative comorbidities and perioperative stressors. AKI is commonly diagnosed by using increases in serum creatinine or decreased urine output and staged using a standardized definition such as the Kidney Disease Improving Global Outcomes classification. Novel biomarkers under investigation may provide earlier detection and better prediction of AKI, enabling mitigating therapies early in the perioperative period. Recent clinical trials of cardiac surgery patients have demonstrated the benefit of goal-directed oxygen delivery, avoidance of hyperthermic perfusion and specific fluid and medication strategies. This review article highlights both advances and limitations regarding the prevention, prediction, and treatment of cardiac surgery-associated AKI.
ISSN:0003-3022
1528-1175
DOI:10.1097/ALN.0000000000004734