Renal Function and Urinary Biomarkers in Cardiac Bypass Surgery: A Prospective Randomized Trial Comparing Three Surgical Techniques

Deininger, Sören‐Oliver; Hoenicka, Markus; Müller-Eising, K.; Rupp, P.; Liebold, Andreas; Köenig, Wolfgang; Gorki, Hagen

doi:10.1055/s-0035-1567871

Cited by 9 publications

(4 citation statements)

References 24 publications

(27 reference statements)

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“…Despite this major role in the pathogenesis of CSA-AKI, the avoidance of CPB has not reliably reduced the incidence of CSA-AKI or longer-term renal outcomes. [5][6][7][8] This evidence does not diminish the importance of CPB in causing renal dysfunction, but rather reflects the importance of the multifactorial aetiology of the disease, and in particular the importance of the haemodynamic changes during offpump surgery. 9 This narrative review will describe the specific pathophysiology of CPB use with respect to renal dysfunction, and the impact it has upon the three domains of renal dysfunction (i.e.…”

Section: Introductionmentioning

confidence: 98%

Adverse renal effects associated with cardiopulmonary bypass

et al. 2023

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Cardiac surgery on cardiopulmonary bypass (CPB) is associated with postoperative renal dysfunction, one of the most common complications of this surgical cohort. Acute kidney injury (AKI) is associated with increased short-term morbidity and mortality and has been the focus of much research. There is increasing recognition of the role of AKI as the key pathophysiological state leading to the disease entities acute and chronic kidney disease (AKD and CKD). In this narrative review, we will consider the epidemiology of renal dysfunction after cardiac surgery on CPB and the clinical manifestations across the spectrum of disease. We will discuss the transition between different states of injury and dysfunction, and, importantly, the relevance to clinicians. The specific facets of kidney injury on extracorporeal circulation will be described and the current evidence evaluated for the use of perfusion-based techniques to reduce the incidence and mitigate the complications of renal dysfunction after cardiac surgery.

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Section: Introductionmentioning

confidence: 98%

Adverse renal effects associated with cardiopulmonary bypass

et al. 2023

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“…conventional CPB, minimally invasive CPB, and off-pump CABG. Temporary superiority of minimally invasive CPB and off-pump surgery was recorded in regard to acute tubular necrosis via free hemoglobin measurement (p<0.001), but with no significant long-term differences 29 .…”

Section: Acute Kidney Injury Risk Factorsmentioning

confidence: 97%

Acute Kidney Injury after Open-Heart Surgery Procedures

Djordjevic¹

2021

ACC

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Cardiac surgery-associated acute kidney injury (CS-AKI) is a major complication associated with increased morbidity and mortality. There are multiple diagnostic criteria for CS-AKI. Despite many new investigations available for improved AKI diagnostics, creatinine and urea remain the cornerstone of diagnostics in everyday clinical practice. There are three major pathophysiological mechanisms that contribute to kidney injury, i.e. renal hypoperfusion, inflammation with oxidative stress, and use of nephrotoxic agents. Some risk factors have been identified that can be modified during the course of treatment (use of nephrotoxic agents, duration of cardiopulmonary bypass, type of extracorporeal circulation, postoperative low cardiac output or hypotension). The aim of AKI prevention should always be to prevent aggravation of renal failure and, if possible, to avoid progression to renal replacement therapy, which in turn brings worse long-term outcomes.

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“…While factors like CPB duration and techniques affect kidney injury, evidence suggests the overall effect of CPB on AKI might be limited, as supported by the HEPCON trial. 177 …”

Section: Intraoperative and Postoperative Strategiesmentioning

confidence: 99%

Cardiac Surgery–Associated Acute Kidney Injury

Scurt,

Bose,

Mertens

et al. 2024

Kidney360

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Acute kidney injury (AKI) is a common and serious complication of cardiac surgery that has a significant impact on patient morbidity and mortality. The Kidney Disease Improving Global Outcomes (KDIGO) definition of AKI is widely used to classify and identify AKI associated with cardiac surgery (CSA-AKI) based on changes in serum creatinine and/or urine output. There are various pre-, intra-, and postoperative risk factors for the development of CSA-AKI which should be recognized and addressed as early as possible to expedite its diagnosis, reduce its occurrence and prevent or ameliorate its devastating complications. Crucial issues are the inaccuracy of serum creatinine as a surrogate parameter of kidney function in the perioperative setting of cardiothoracic surgery and the necessity to discover more representative markers of the pathophysiology of AKI. However, except for the tissue inhibitor of metalloproteinase-2 and insulin-like growth factor binding protein 7 ratio (TIMP2/IGFBP7), other diagnostic biomarkers with an acceptable sensitivity and specificity are still lacking. This article provides a comprehensive review of various aspects of CSA-AKI, including pathogenesis, risk factors, diagnosis, biomarkers, classification, prevention and treatment management.

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Renal Function and Urinary Biomarkers in Cardiac Bypass Surgery: A Prospective Randomized Trial Comparing Three Surgical Techniques

Cited by 9 publications

References 24 publications

Adverse renal effects associated with cardiopulmonary bypass

Adverse renal effects associated with cardiopulmonary bypass

Acute Kidney Injury after Open-Heart Surgery Procedures

Cardiac Surgery–Associated Acute Kidney Injury

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