Alan M Gaffney1, Robert N Sladen. 1. Department of Anesthesiology, College of Physicians and Surgeons of Columbia University, New York, USA.
Abstract
PURPOSE OF REVIEW: Acute kidney injury (AKI) is a long-recognized complication of cardiac surgery. It is a commonly encountered clinical syndrome that, in its most severe form, increases the odds of operative mortality three to eight-fold. The pathogenesis of cardiac surgery-associated acute kidney injury (CSA-AKI) is complex. No single intervention is likely to provide a panacea, and thus, the purpose of this review is to assess the wide breadth of emerging research into potential strategies to prevent, diagnose, and treat CSA-AKI. RECENT FINDINGS: Research in the field of CSA-AKI published within the last 18 months adds further layers of knowledge to many previously studied areas. These include its definition (Risk, Injury, Failure, Loss, End-stage kidney disease, Acute Kidney Injury Network, and Kidney Disease: Improving Global Outcomes criteria), diagnosis (biomarkers and intraoperative renal oximetry), prevention (statin therapy, acetylsalicylic acid, N-acetylcysteine, sodium bicarbonate, off-pump coronary revascularization, goal-directed hemodynamic therapy, and minimizing blood transfusion), and treatment (early initiation of renal replacement therapy). SUMMARY: Although there has been much high-quality research conducted in this field in recent years, preventing CSA-AKI by avoiding renal insults remains the mainstay of management. Although biomarkers have the potential to diagnose CSA-AKI at an earlier stage, efficacious interventions to treat established CSA-AKI remain elusive.
PURPOSE OF REVIEW: Acute kidney injury (AKI) is a long-recognized complication of cardiac surgery. It is a commonly encountered clinical syndrome that, in its most severe form, increases the odds of operative mortality three to eight-fold. The pathogenesis of cardiac surgery-associated acute kidney injury (CSA-AKI) is complex. No single intervention is likely to provide a panacea, and thus, the purpose of this review is to assess the wide breadth of emerging research into potential strategies to prevent, diagnose, and treat CSA-AKI. RECENT FINDINGS: Research in the field of CSA-AKI published within the last 18 months adds further layers of knowledge to many previously studied areas. These include its definition (Risk, Injury, Failure, Loss, End-stage kidney disease, Acute Kidney Injury Network, and Kidney Disease: Improving Global Outcomes criteria), diagnosis (biomarkers and intraoperative renal oximetry), prevention (statin therapy, acetylsalicylic acid, N-acetylcysteine, sodium bicarbonate, off-pump coronary revascularization, goal-directed hemodynamic therapy, and minimizing blood transfusion), and treatment (early initiation of renal replacement therapy). SUMMARY: Although there has been much high-quality research conducted in this field in recent years, preventing CSA-AKI by avoiding renal insults remains the mainstay of management. Although biomarkers have the potential to diagnose CSA-AKI at an earlier stage, efficacious interventions to treat established CSA-AKI remain elusive.
Authors: Zhaneta V Vesnina; Yury B Lishmanov; Ekaterina A Alexandrova; Evgeniy A Nesterov Journal: Cardiorenal Med Date: 2016-06-22 Impact factor: 2.041
Authors: Natalie A Silverton; Lars R Lofgren; Isaac E Hall; Gregory J Stoddard; Natalia P Melendez; Michael Van Tienderen; Spencer Shumway; Bradley J Stringer; Woon-Seok Kang; Carter Lybbert; Kai Kuck Journal: Anesthesiology Date: 2021-09-01 Impact factor: 8.986