Review

. 2024 Jul 12;13(1):72.

doi: 10.1186/s13741-024-00416-5.

Optimization of kidney function in cardiac surgery patients with intra-abdominal hypertension: expert opinion

Vanessa Moll^{1

2}, Ashish K Khanna^{3

4

5}, Andrea Kurz^{6

7}, Jiapeng Huang⁸, Marije Smit⁹, Madhav Swaminathan¹⁰, Steven Minear¹¹, K Gage Parr¹², Amit Prabhakar², Manxu Zhao¹³, Manu L N G Malbrain^{14

15

16}

Affiliations

¹ Department of Anesthesiology, Division of Critical Care Medicine, University of Minnesota, Minneapolis, MN, USA.
² Department of Anesthesiology, Division of Critical Care Medicine, Emory School of Medicine, Atlanta, GA, USA.
³ Wake Forest University School of Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, USA.
⁴ Perioperative Outcomes and Informatics Collaborative (POIC), Winston-Salem, NC, USA.
⁵ Outcomes Research Consortium, Cleveland, OH, USA.
⁶ Departments of General Anesthesiology and Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA.
⁷ Department of Anesthesiology, Emergency Medicine and Intensive Care Medicine, Medical University Graz, Graz, Austria.
⁸ Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY, USA.
⁹ Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.
¹⁰ Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA.
¹¹ Department of Anesthesiology, Cleveland Clinic Florida, Weston Hospital, Weston, FL, USA.
¹² Department of Anesthesiology and Critical Care Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
¹³ Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
¹⁴ First Department of Anaesthesiology and Intensive Therapy, Medical University Lublin, Lublin, Poland. manu.malbrain@umlub.pl.
¹⁵ Medical Data Management, Medaman, Geel, Belgium. manu.malbrain@umlub.pl.
¹⁶ International Fluid Academy, Lovenjoel, Belgium. manu.malbrain@umlub.pl.

PMID: 38997752
PMCID: PMC11245849
DOI: 10.1186/s13741-024-00416-5

Review

Optimization of kidney function in cardiac surgery patients with intra-abdominal hypertension: expert opinion

Vanessa Moll et al. Perioper Med (Lond). 2024.

. 2024 Jul 12;13(1):72.

doi: 10.1186/s13741-024-00416-5.

Authors

Affiliations

¹ Department of Anesthesiology, Division of Critical Care Medicine, University of Minnesota, Minneapolis, MN, USA.
² Department of Anesthesiology, Division of Critical Care Medicine, Emory School of Medicine, Atlanta, GA, USA.
³ Wake Forest University School of Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, USA.
⁴ Perioperative Outcomes and Informatics Collaborative (POIC), Winston-Salem, NC, USA.
⁵ Outcomes Research Consortium, Cleveland, OH, USA.
⁶ Departments of General Anesthesiology and Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA.
⁷ Department of Anesthesiology, Emergency Medicine and Intensive Care Medicine, Medical University Graz, Graz, Austria.
⁸ Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY, USA.
⁹ Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.
¹⁰ Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA.
¹¹ Department of Anesthesiology, Cleveland Clinic Florida, Weston Hospital, Weston, FL, USA.
¹² Department of Anesthesiology and Critical Care Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
¹³ Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
¹⁴ First Department of Anaesthesiology and Intensive Therapy, Medical University Lublin, Lublin, Poland. manu.malbrain@umlub.pl.
¹⁵ Medical Data Management, Medaman, Geel, Belgium. manu.malbrain@umlub.pl.
¹⁶ International Fluid Academy, Lovenjoel, Belgium. manu.malbrain@umlub.pl.

PMID: 38997752
PMCID: PMC11245849
DOI: 10.1186/s13741-024-00416-5

Erratum in

Correction: Optimization of kidney function in cardiac surgery patients with intra-abdominal hypertension: expert opinion.
Moll V, Khanna AK, Kurz A, Huang J, Smit M, Swaminathan M, Minear S, Parr KG, Prabhakar A, Zhao M, Malbrain MLNG. Moll V, et al. Perioper Med (Lond). 2024 Jul 29;13(1):85. doi: 10.1186/s13741-024-00444-1. Perioper Med (Lond). 2024. PMID: 39075539 Free PMC article. No abstract available.

Abstract

Cardiac surgery-associated acute kidney injury (CSA-AKI) affects up to 42% of cardiac surgery patients. CSA-AKI is multifactorial, with low abdominal perfusion pressure often overlooked. Abdominal perfusion pressure is calculated as mean arterial pressure minus intra-abdominal pressure (IAP). IAH decreases cardiac output and compresses the renal vasculature and renal parenchyma. Recent studies have highlighted the frequent occurrence of IAH in cardiac surgery patients and have linked the role of low perfusion pressure to the occurrence of AKI. This review and expert opinion illustrate current evidence on the pathophysiology, diagnosis, and therapy of IAH and ACS in the context of AKI.

Keywords: Abdominal-perfusion pressure; Acute kidney injury; Cardiac surgery; Continuous intra-abdominal pressure; Intra-abdominal pressure; Management; Monitoring; Prevention.

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Conflict of interest statement

A.K. Khanna, A. Kurz, M. Smit, M. Swaminathan, S. Minear, K.G. Parr, M. Zhao, and A. Prabhakar declare no support from any organization for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work. AKK is a paid consultant for and chairs the steering committee for the Predict AKI group for Accuryn Medical and also consults for Edwards Lifesciences, Philips Research North America, GE Healthcare, Baxter, and Caretaker Medical. His institution has grant funding from Caretaker Medical for ongoing investigations on portable hemodynamic monitoring. AKK is on the executive advisory board for Medtronic and Retia Medical. AKK receives support from the Wake Forest CTSI via NIH/NCATS KL2 for a trial of continuous portable hemodynamic and saturation monitoring in hospital wards. MLNGM is a member of the medical advisory Board of Pulsion Medical Systems (part of Getinge group), Serenno Medical, Accuryn Medical, Sentinel Medical, and Baxter. He consults for BBraun, Becton Dickinson, ConvaTec, Spiegelberg, MedCaptain, and Holtech Medical, and received speaker’s fees from PeerVoice. He holds stock options for Serenno Medical. He is co-founder, past-President, and current Treasurer of WSACS (The Abdominal Compartment Society, http://www.wsacs.org). He is a co-founder and President of the International Fluid Academy (IFA). The IFA (http://www.fluidacademy.org) is integrated within the not-for-profit charitable organization iMERiT, International Medical Education and Research Initiative, under Belgian law. VM, AKK, AK, MS, JH, and MLNGM are members of the steering committee for the Predict AKI group for Accuryn Medical. VM served from August 2021 to July 2023 as Chief Medical Officer for Accuryn Medical, Hayward, CA, USA.

Cited by

Correction: Optimization of kidney function in cardiac surgery patients with intra-abdominal hypertension: expert opinion.
Moll V, Khanna AK, Kurz A, Huang J, Smit M, Swaminathan M, Minear S, Parr KG, Prabhakar A, Zhao M, Malbrain MLNG. Moll V, et al. Perioper Med (Lond). 2024 Jul 29;13(1):85. doi: 10.1186/s13741-024-00444-1. Perioper Med (Lond). 2024. PMID: 39075539 Free PMC article. No abstract available.
Relationship between intra-bladder pressure and acute kidney injury in patients with acute pancreatitis: interpretable machine learning approach.
Liao G, Ye B, Li J, Wen M. Liao G, et al. BMC Nephrol. 2025 Aug 13;26(1):459. doi: 10.1186/s12882-025-04371-1. BMC Nephrol. 2025. PMID: 40804605 Free PMC article.
The role of hydroxyethyl starch in perioperative acute kidney injury. Comment on Br J Anaesth 2024; 133: 1263-75.
Kopitkó C, Fülöp T, Gondos T. Kopitkó C, et al. Br J Anaesth. 2025 Mar;134(3):862-864. doi: 10.1016/j.bja.2024.11.037. Epub 2025 Jan 18. Br J Anaesth. 2025. PMID: 39826990 Free PMC article. No abstract available.
International cross-sectional survey on current and updated definitions of intra-abdominal hypertension and abdominal compartment syndrome.
Nasa P, Wise RD, Smit M, Acosta S, D'Amours S, Beaubien-Souligny W, Bodnar Z, Coccolini F, Dangayach NS, Dabrowski W, Duchesne J, Ejike JC, Augustin G, De Keulenaer B, Kirkpatrick AW, Khanna AK, Kimball E, Koratala A, Lee RK, Leppaniemi A, Lerma EV, Marmolejo V, Meraz-Munoz A, Myatra SN, Niven D, Olvera C, Ordoñez C, Petro C, Pereira BM, Ronco C, Regli A, Roberts DJ, Rola P, Rosen M, Shrestha GS, Sugrue M, Velez JCQ, Wald R, De Waele J, Reintam Blaser A, Malbrain MLNG. Nasa P, et al. World J Emerg Surg. 2024 Nov 29;19(1):39. doi: 10.1186/s13017-024-00564-5. World J Emerg Surg. 2024. PMID: 39609850 Free PMC article.

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Optimization of kidney function in cardiac surgery patients with intra-abdominal hypertension: expert opinion

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Optimization of kidney function in cardiac surgery patients with intra-abdominal hypertension: expert opinion

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