Acute kidney injury following cardiac surgery: current understanding and future directions

Abstract

Acute kidney injury (AKI) complicates recovery from cardiac surgery in up to 30 % of patients, injures and impairs the function of the brain, lungs, and gut, and places patients at a 5-fold increased risk of death during hospitalization. Renal ischemia, reperfusion, inflammation, hemolysis, oxidative stress, cholesterol emboli, and toxins contribute to the development and progression of AKI. Preventive strategies are limited, but current evidence supports maintenance of renal perfusion and intravascular volume while avoiding venous congestion, administration of balanced salt as opposed to high-chloride intravenous fluids, and the avoidance or limitation of cardiopulmonary bypass exposure. AKI that requires renal replacement therapy occurs in 2–5 % of patients following cardiac surgery and is associated with 50 % mortality. For those who recover from renal replacement therapy or even mild AKI, progression to chronic kidney disease in the ensuing months and years is more likely than for those who do not develop AKI. Cardiac surgery continues to be a popular clinical model to evaluate novel therapeutics, off-label use of existing medications, and nonpharmacologic treatments for AKI, since cardiac surgery is fairly common, typically elective, provides a relatively standardized insult, and patients remain hospitalized and monitored following surgery. More efficient and time-sensitive methods to diagnose AKI are imperative to reduce this negative outcome. The discovery and validation of renal damage biomarkers should in time supplant creatinine-based criteria for the clinical diagnosis of AKI.

Acute Kidney Injury Following Cardiopulmonary Bypass in Children ― Risk Factors and Outcomes ―

“…14 These factors alter renal perfusion, induce cycles of ischemia and reperfusion, increase oxidative damage, increase renal and systemic inflammation, and contribute to the development of AKI. 14, 15 To date, there are many diagnostic criteria and biomarkers for AKI diagnosis, because the incidence of AKI varies according to age and other criteria. Based on previous studies, the incidence of AKI following pediatric cardiac surgery varies from 3% to 52% and dialysis is required in in this study should be used to predict the development of severe AKI.…”

Incidencia acumulada de insuficiencia renal aguda en el posoperatorio de cirugía cardíaca

“…También la hemodilución que se genera durante la CEC sería responsable de isquemia renal medular (9,10,12) . La canulación y el clampeo aórtico se asocian con incremento de fenómenos ateroembólicos renales que exacerban la isquemia e inducen inflamación (26) . Sin embargo, el efecto protector de la cirugía sin CEC sobre la incidencia de IRA sigue siendo controvertido.…”

Myocardium protection against ischemic-reperfusion injury by nitric oxide supplied to the extracorporeal circulation line during cardiopulmonary bypass (experimental study)

“…Кардиохирургические пациенты имеют повышенный риск острого повреждения почек и желудочно-кишеч-ного тракта, особенно при необходимости сочетанной операции [22]. Развитие гемолиза вследствие длительного ИК и применения компонентов донорской крови, а также ограничение NO-биодоступности приводят к расстройс-твам микроциркуляции и системным аберрациям органно-го кровотока [23].…”