Analysis of Risk Factors for Perioperative Acute Kidney Injury and Management Strategies

Abstract

Acute kidney injury (AKI) is a serious clinical syndrome, and one of the common comorbidities in the perioperative period. AKI can lead to complications in surgical patients and is receiving increasing attention in clinical workup. In recent years, the analysis of perioperative risk factors has become more in-depth and detailed. In this review, the definition, diagnosis, and pathophysiological characteristics of perioperative AKI are reviewed, and the main risk factors for perioperative AKI are analyzed, including advanced age, gender, certain underlying diseases, impaired clinical status such as preoperative creatinine levels, and drugs that may impair renal function such as non-steroidal anti-inflammatory drugs (NASIDs), ACEI/ARB, and some antibiotics. Injectable contrast agents, some anesthetic drugs, specific surgical interventions, anemia, blood transfusions, hyperglycemia, and malnutrition are also highlighted. We also propose potential preventive and curative measures, including the inclusion of renal risk confirmation in the preoperative assessment, minimization of intraoperative renal toxin exposure, intraoperative management and hemodynamic optimization, remote ischemic preadaptation, glycemic control, and nutritional support. Among the management measures, we emphasize the need for careful perioperative clinical examination, timely detection and management of AKI complications, administration of dexmedetomidine for renal protection, and renal replacement therapy. We aim that this review can further increase clinicians' attention to perioperative AKI, early assessment and intervention to try to reduce the risk of AKI.

Future Directions in Optimizing Anesthesia to Reduce Perioperative Acute Kidney Injury

“…Increased oxidative stress, intraabdominal hypertension, inflammation, and underestimated fluid requirements [35,36] Creatinine >106 mol/L [24] Underlying diseases CKD Decreased kidney function [24] Peripheral vascular disease [37]…”

“…Glucose metabolism disorder could generate many glycosylation products, which are then deposited in glomerular endothelial cells, thereby causing inflammation [39] Congestive heart failure Sudden decrease in renal blood flow and GFR [40] COPD Airflow limitation, which may lead to chronic renal hypoxia [41] Malnutrition Significant changes in renal hemodynamics and renal concentration capacity [42] Sepsis, crush injury, liver failure Acute preoperative factors [18] Drugs ACEI/ARB Renal arterial vasoconstriction leading to renal hypoperfusion; low blood pressure [43,44] NSAIDs Directly reduces renal blood flow and inhibits vasodilatory prostaglandins, thus leading to renal vasoconstriction; may cause interstitial nephritis [24,26] Diuretics Low blood volume [39] Several antibiotics (like β-lactam, neoquinolones, and aminoglycosides) Dose-dependent tubular necrosis; allergic tubulointerstitial nephritis; tubular crystal formation [45,46] Intravenous/ arterial contrast agents Direct toxic effects; renal medullary hypoxia caused by changes in renal hemodynamics; renal microcirculation disturbances [24] Intraoperative risk factors…”

Tilianin Reduces Apoptosis via the ERK/EGR1/BCL2L1 Pathway in Ischemia/Reperfusion-Induced Acute Kidney Injury Mice

“…Acute kidney injury (AKI), a common clinical syndrome, is defined as a rapid decrease in kidney function (Kellum et al, 2013;Yu and Feng, 2021;Zhong and He, 2021), with 10-15% of inpatients suffering from it, while the frequency is up to 50% in the intensive care unit (Al-Jaghbeer et al, 2018). As one of the major etiology of AKI, ischemia/reperfusion (I/R)-induced AKI develops in the context of many clinical conditions such as kidney transplantation, cardiac, and vascular surgery (Lameire et al, 2013).…”

Scutellarin protects the kidney from ischemia/reperfusion injury by targeting Nrf2

“…Acute kidney injury (AKI), a common and critical condition in clinical practice, characterized by a rapid decline in kidney function, results in high morbidity and mortality 1 . Approximately 8%–16% of inpatients suffered from AKI, of which 65% deceased due to delayed diagnosis and absence of renal replacement therapy (RRT), 2 while survivors face a high risk of chronic kidney disease (CKD) 3 .…”

“…Acute kidney injury (AKI), a common and critical condition in clinical practice, characterized by a rapid decline in kidney function, results in high morbidity and mortality. 1 Approximately 8%-16% of inpatients suffered from AKI, of which 65% deceased due to delayed diagnosis and absence of renal replacement therapy (RRT), 2 while survivors face a high risk of chronic kidney disease (CKD). 3 In recent years, the number of patients who suffered from I/R-AKI continuously increased, finally progressing to CKD or even end-stage renal disease that required RRT such as dialysis and renal transplantation, 2 while there is rare intervention except for RRT.…”