Cardiac Surgery-Associated Acute Kidney Injury

Cardiorenal Medicine

Anna Giuliani¹  Huijuan Mao¹  Elisa Scalzotto¹  Akash Nayak¹  Wassawon Ariyanon¹  Nevin Katz¹  Jeong Chul Kim¹  Mauro Neri¹  Loris Salvador¹  Zelal Adýbelli¹  Claudio Ronco¹  Grazia Maria Virzi¹  Lourdes Blanca-Martos¹  Tommaso Hinna Danesi¹  Alessandra Brocca¹ 

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关键词: Acute kidney injury;    Cardiac surgical procedures;    Cardiopulmonary bypass;    Renal replacement therapy;   

DOI  :  10.1159/000353134

学科分类：心脏病和心血管学

来源: S Karger AG

【 摘 要 】

Cardiac surgery-associated acute kidney injury (CSA-AKI) is a common and serious postoperative complication of cardiac surgery requiring cardiopulmonary bypass (CPB), and it is the second most common cause of AKI in the intensive care unit. Although the complication has been associated with the use of CPB, the etiology is likely multifactorial and related to intraoperative and early postoperative management including pharmacologic therapy. To date, very little evidence from randomized trials supporting specific interventions to protect from or prevent AKI in broad cardiac surgery populations has been found. The definition of AKI employed by investigators influences not only the incidence of CSA-AKI, but also the identification of risk variables. The advent of novel biomarkers of kidney injury has the potential to facilitate the subclinical diagnosis of CSA-AKI, the assessment of its severity and prognosis, and the early institution of interventions to prevent or reduce kidney damage. Further studies are needed to determine how to optimize cardiac surgical procedures, CPB parameters, and intraoperative and early postoperative blood pressure and renal blood flow to reduce the risk of CSA-AKI. No pharmacologic strategy has demonstrated clear efficacy in the prevention of CSA-AKI; however, some agents, such as the natriuretic peptide nesiritide and the dopamine agonist fenoldopam, have shown promising results in renoprotection. It remains unclear whether CSA-AKI patients can benefit from the early institution of such pharmacologic agents or the early initiation of renal replacement therapy.

【 授权许可】

Unknown