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Review
. 2023 Dec 1;139(6):880-898.
doi: 10.1097/ALN.0000000000004734.

Acute Kidney Injury after Cardiac Surgery: Prediction, Prevention, and Management

Sreekanth R Cheruku  1 , Jacob Raphael  2 , Javier A Neyra  3 , Amanda A Fox  4
Affiliations
Review

Acute Kidney Injury after Cardiac Surgery: Prediction, Prevention, and Management

Sreekanth R Cheruku et al. Anesthesiology. .

Abstract

Acute kidney injury (AKI) is a common complication in cardiac surgery patients, with a reported incidence of 20 to 30%. The development of AKI is associated with worse short- and long-term mortality, and longer hospital length of stay. The pathogenesis of cardiac surgery-associated AKI is poorly understood but likely involves an interplay between preoperative comorbidities and perioperative stressors. AKI is commonly diagnosed by using increases in serum creatinine or decreased urine output and staged using a standardized definition such as the Kidney Disease Improving Global Outcomes classification. Novel biomarkers under investigation may provide earlier detection and better prediction of AKI, enabling mitigating therapies early in the perioperative period. Recent clinical trials of cardiac surgery patients have demonstrated the benefit of goal-directed oxygen delivery, avoidance of hyperthermic perfusion and specific fluid and medication strategies. This review article highlights both advances and limitations regarding the prevention, prediction, and treatment of cardiac surgery-associated AKI.

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Conflict of interest statement

Conflicts of Interest: JR has consulted for Octapharma USA, Inc. JAN is supported by JAN has received consulting honoraria from Baxter, Outset, Vifor, and AcelRx.

Figures

Figure 1.
Figure 1.
Pathophysiology of Cardiac Surgery-Associated Acute Kidney Injury.
Figure 2.
Figure 2.
Timeline highlighting the potential for novel biomarkers to identify AKI as compared to serum creatinine-based criteria. AKI, acute kidney injury. SCr, Serum creatinine.
See this image and copyright information in PMC

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