CSA-AKI: Incidence, Epidemiology, Clinical Outcomes, and Economic Impact

Abstract

Cardiac surgery-associated acute kidney injury (CSA-AKI) is a common complication following cardiac surgery and reflects a complex biological combination of patient pathology, perioperative stress, and medical management. Current diagnostic criteria, though increasingly standardized, are predicated on loss of renal function (as measured by functional biomarkers of the kidney). The addition of new diagnostic injury biomarkers to clinical practice has shown promise in identifying patients at risk of renal injury earlier in their course. The accurate and timely identification of a high-risk population may allow for bundled interventions to prevent the development of CSA-AKI, but further validation of these interventions is necessary. Once the diagnosis of CSA-AKI is established, evidence-based treatment is limited to supportive care. The cost of CSA-AKI is difficult to accurately estimate, given the diverse ways in which it impacts patient outcomes, from ICU length of stay to post-hospital rehabilitation to progression to CKD and ESRD. However, with the global rise in cardiac surgery volume, these costs are large and growing.

Keywords: acute kidney injury; cardiac surgery; clinical nephrology; epidemiology; mortality; outcomes; renal replacement therapy.

Figure 1

Pathophysiology of AKI (reproduced from ADQI by Nadim et al., 2018 [5]). From https://pittccmblob.blob.core.windows.net/adqi/20fig.pdf (accessed on 6 December 2021).