Cardiac surgery and acute kidney injury: emerging concepts

Abstract

Purpose of review: To review recent advances in understanding of the occurrence, pathophysiology, prophylaxis and treatment of cardiac surgery-associated acute kidney injury (AKI).

Recent findings: New definitions and prompt diagnostic tools, enhanced risk stratification strategies, avoidance of nephrotoxins and procedure selection are all areas in which recent contributions to the literature have improved perioperative care for cardiac surgery patients. Although evidence continues to confirm the adverse effects of extreme hemodilution and transfusion as part of cardiac surgery, the previously believed advantages of tight perioperative glucose control for the kidney are being questioned in recent studies. Although very little evidence from randomized trials in cardiac surgery populations supports specific interventions to protect or prevent AKI, recent reports indicate reduced AKI associated with some procedural innovations, and the hope that promising findings for agents such as sodium bicarbonate that require further study may yield effective therapies.

Summary: The vexing problem of AKI following cardiac surgery is common and unsolved. Clinical strategies that stress avoidance rather than treatment remain the mainstay of effective management of patients at high renal risk.