AKI Associated with Cardiac Surgery

Abstract

Approximately 18% of patients undergoing cardiac surgery experience AKI (on the basis of modern standardized definitions of AKI), and approximately 2%-6% will require hemodialysis. The development of AKI after cardiac surgery portends poor short-and long-term prognoses, with those developing RIFLE failure or AKI Network stage III having an almost 2-fold increase in the risk of death. AKI is caused by a variety of factors, including nephrotoxins, hypoxia, mechanical trauma, inflammation, cardiopulmonary bypass, and hemodynamic instability, and it may be affected by the clinician's choice of fluids and vasoactive agents as well as the transfusion strategy used. The risk of AKI may be ameliorated by avoidance of nephrotoxins, achievement of adequate glucose control preoperatively, and use of goal-directed therapy hemodynamic strategies. Remote ischemic preconditioning is an exciting future strategy, but more work is needed before widespread implementation. Unfortunately, there are no pharmacologic agents known to reduce the risk of AKI or treat established AKI.

Endovascular aneurysm repair (EVAR)– and transcatheter aortic valve replacement (TAVR)–associated acute kidney injury

“…The kidney is susceptible to hemodynamic injury with TAVR, similar to CABG or SAVR. 104 Multiple ischemic insults can lead to cellular ischemia and acute tubular necrosis (ATN). Hypotension from bleeding, sepsis, heart-failure, and rapid ventricular pacing can lead to decreased renal perfusion and renal ischemic insults.…”

Incidence and mortality of postoperative acute kidney injury in non-dialysis patients: comparison between the AKIN and KDIGO criteria

“…Based on KDIGO and AKIN criteria, patients without AKI were used as a reference group. Student's t test, 2 , MannWhitney U, or Kruskal-Wallis tests are used to determine the differences in the demographic data, underlying disease, surgery category, scoring system, the laboratory variables, and the use of vasoactive and diuretics between patients with postoperative non-dialysis AKI and the non-AKI group. The in-hospital cumulative survival function is estimated using the Kaplan-Meier method.…”

Neuroprotective and nephroprotective effects of remote postconditioning: Prospects for clinical use

“…Кардиоренальный синдром, характеризующийся острым поражением почек, по данным некоторых авторов, отмечается у 18% кардиохирургических пациентов [43], примерно 2-6% боль-ных, перенесших операцию на сердце, нуждаются в гемодиализе [43]. Как полагают [44], главным патогенетическим фактором, способствующим возникновению кардиоренального синдрома, является системная воспалительная реакция на кардиохирурги-ческое вмешательство.…”