Hemodynamic Instability during Acute Kidney Injury and Acute Renal Replacement Therapy: Pathophysiology and Clinical Implications

Abstract

Hemodynamic instability associated with acute renal replacement therapy (aRRT, HIRRT) and/or with acute kidney injury (AKI) is frequently observed in the intensive care unit; it affects patients’ renal recovery, and negatively impacts short- and long-term mortality. A thorough understanding of mechanisms underlying HIRRT and AKI-related hemodynamic instability may allow the physician in adopting adequate strategies to prevent their occurrence and reduce their negative consequences. The aim of this review is to summarize the main alterations occurring in patients with AKI and/or requiring aRRT of those homeostatic mechanisms which regulate hemodynamics and oxygen delivery. In particular, a pathophysiological approach has been used to describe the maladaptive interactions between cardiac output and systemic vascular resistance occurring in these patients and leading to hemodynamic instability. Finally, the potential positive effects of aRRT on these pathophysiological mechanisms and on restoring hemodynamic stability have been described.

Does cardiac impairment develop in ischemic renal surgery in rats depending on the reperfusion time?

“…The induction of cardiac failure following renal surgery is a complex phenomenon influenced by various factors [ 45 ]. Hemodynamic changes associated with renal surgery, including alterations in blood volume and fluid balance, can impact cardiac preload, afterload, and contractility, potentially leading to cardiac dysfunction [ 45 ].…”

“…The induction of cardiac failure following renal surgery is a complex phenomenon influenced by various factors [ 45 ]. Hemodynamic changes associated with renal surgery, including alterations in blood volume and fluid balance, can impact cardiac preload, afterload, and contractility, potentially leading to cardiac dysfunction [ 45 ]. Electrolyte imbalances, particularly hyperkalemia, arising from surgical interventions can disrupt normal cardiac electrical conduction and contractility, contributing to arrhythmias and cardiac failure [ 46 , 47 ].…”

Acute kidney injury post-abdominal surgery in infants: implications for prevention and management

“…Hypotension and vasopressor requirement during abdominal surgery are associated with postoperative AKI. Hypotension leads to kidney hypoperfusion and thus AKI (28,52,53). Renal hypoperfusion can occur for many reasons, including excessive blood loss, sepsis with capillary leak, or inadequate fluid replacement (54) Lower intraoperative systolic blood pressure is associated with postoperative AKI (10).…”

A Novel Role of Semaphorin 3C in Modulating Systemic and Renal Hemodynamics

“…Nephron 2023;147:434-440 DOI: 10.1159/000528259 that instability of systemic hemodynamics is closely related to multiorgan dysfunction and adverse outcomes in AKI [7], it is highly warranted to investigate the acute and direct effect of SEMA3C on systemic and/or renal hemodynamics, which hitherto remained largely unknown.…”