Peri‐operative renal dysfunction: prevention and management

Golden, David B.K.; Corbett, Jade Marie; Forni, Lui G.

doi:10.1111/anae.13313

Cited by 22 publications

(26 citation statements)

References 77 publications

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“…This is in keeping with other previously reported studies . Although risk scoring systems have been devised to aid in identifying surgical patients at highest risk, outside of cardiac surgery these perform poorly, as risk stratification has been hampered by variable definitions of AKI and inconsistent outcomes . A recent systematic review of risk prediction models following non‐cardiac surgery found currently available models lacked external validation and robust impact analyses, and recommended that further data were needed before clinical use could be recommended .…”

Section: Non‐modifiable Risk Factorssupporting

confidence: 81%

“…Despite the heterogeneity in terms of potential pathophysiology, there is a degree of consistency across surgical specialties with regard to risk factors for AKI, as outlined in Table . Common risk factors include the presence of vascular disease, CKD, hypertension, cardiac failure and diabetes, all of which are strongly associated with postoperative AKI . However, the incidence of AKI is also procedurally related.…”

Section: Who Is At Risk Of Renal Complications?mentioning

confidence: 99%

“…However, similar neuroendocrine responses following pain, trauma and surgery may result in oliguria in the absence of haemodynamic compromise. Under such circumstances, over‐zealous fluid administration may be harmful .…”

Section: The Postoperative Approachmentioning

confidence: 99%

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Renal complications of anaesthesia

2018

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SummaryPeri-operative acute kidney injury is common, accounting for 30-40% of all in-hospital cases of acute kidney injury. It is associated with clinically significant morbidity and mortality even with what was hitherto regarded as relatively trivial increases in serum creatinine, and carries over a 12-fold relative risk of death following major abdominal surgery. Comorbid conditions such as diabetes, hypertension, liver disease and particularly pre-existing chronic kidney disease, as well as the type and urgency of surgery, are major risk factors for the development of postoperative acute kidney injury. As yet, there are no specific treatment options for the injured kidney, although there are several modifiable risk factors of which the anaesthetist should be aware. As well as the avoidance of potential nephrotoxins and appropriate volume balance, optimal anaesthetic management should aim to reduce the risk of postoperative renal complications. This may include careful ventilatory management and blood pressure control, as well as appropriate analgesic strategies. The choice of anaesthetic agent may also influence renal outcomes. Rather than concentrate on the classical management of acute kidney injury, this review focuses on the potential development of acute kidney injury peri-operatively, and the means by which this may be ameliorated.

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Section: Non‐modifiable Risk Factorssupporting

confidence: 81%

Section: Who Is At Risk Of Renal Complications?mentioning

confidence: 99%

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Renal complications of anaesthesia

2018

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“…Common patients' related risk factors include chronic vascular disease, chronic kidney disease, arterial hypertension, cardiac failure, and diabetes, all of which are strongly associated with postoperative AKI [11]. In addition, AKI occurrence is also surgery related.…”

Section: Clinical Prediction Scoresmentioning

confidence: 99%

Perioperative Acute Kidney Injury: Prevention, Early Recognition, and Supportive Measures

Romagnoli

Ricci

Ronco

2018

Nephron

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Background: Acute kidney injury (AKI) is a frequent complication of both cardiac and major non-cardiac surgery. AKI is independently associated with morbidity, mortality, and long-term adverse events including chronic kidney disease in postsurgical patients. Since specific treatment options for kidney failure are very limited, early identification, diagnosis, and renal support strategies are key steps to improve patients’ outcome. Summary: According to current Kidney Disease: Improving Global Outcomes (KDIGO) guidelines, AKI diagnosis is based on 2 functional markers, serum creatinine increase and urine output decrease, that are not renal-specific and have important limitations. However, preoperative risk stratification for postoperative AKI and/or early diagnosis after surgery could be the best way to apply preventive or timely supportive therapeutic measures. Clinical prediction scores, renal functional reserve assessment, and new biomarkers of kidney stress (suppression of tumorigenicity-2, insulin-like growth factor binding protein-7, tissue inhibitor metalloproteinase-2) may help the clinicians to identify patients at risk of AKI and that could benefit from the application of nephroprotective bundles suggested by the KDIGO guidelines. In severe AKI patients with oligoanuria and fluid accumulation, renal replacement therapy is the only supportive measure even if mode and timing remain open to investigation. Key messages: Perioperative AKI is an important and underdiagnosed complication. Identifying patients at high risk of AKI and diagnosing AKI early are major goals. Preventive interventions are mainly based on the KDIGO guidelines and bundles. Furthermore, a personalized multidisciplinary approach should always be considered to minimize the progression of disease and the complications related to kidney damage.

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“…Urine flow is a simple measure of renal perfusion and the balance of water and salt: it is integral to the definition of kidney injury under most circumstances. Unfortunately, peri‐operative urine output is a misleading warning siren, to the extent that intravenous infusions in response to postoperative oliguria may be doing more harm than good .…”

mentioning

confidence: 99%