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Cardiorenal Med. 2013 Oct;3(3):178-99. doi: 10.1159/000353134.

Cardiac surgery-associated acute kidney injury.

Author information

  • 1Department of Nephrology, Ospedale San Bortolo, Vicenza, Italy ; Department of International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy ; Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
  • 2Department of Surgery, Johns Hopkins University, Baltimore, Md., USA.
  • 3Department of International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy ; Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand ; Cardiometabolic Centre, BNH Hospital, Bangkok, Thailand.
  • 4Department of International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy ; Department of Nephrology, Hospital Universitario Carlos Haya, Málaga, Spain.
  • 5Department of Nephrology, Ospedale San Bortolo, Vicenza, Italy ; Department of International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy.
  • 6Department of Nephrology, Ospedale San Bortolo, Vicenza, Italy ; Department of International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy ; Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy.
  • 7Department of Cardiac Surgery, Ospedale San Bortolo, Vicenza, Italy.
  • 8Department of International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy ; Department of Chemical Engineering and Economics BITS Pilani, Pilani, India.

Abstract

Cardiac surgery-associated acute kidney injury (CSA-AKI) is a common and serious postoperative complication of cardiac surgery requiring cardiopulmonary bypass (CPB), and it is the second most common cause of AKI in the intensive care unit. Although the complication has been associated with the use of CPB, the etiology is likely multifactorial and related to intraoperative and early postoperative management including pharmacologic therapy. To date, very little evidence from randomized trials supporting specific interventions to protect from or prevent AKI in broad cardiac surgery populations has been found. The definition of AKI employed by investigators influences not only the incidence of CSA-AKI, but also the identification of risk variables. The advent of novel biomarkers of kidney injury has the potential to facilitate the subclinical diagnosis of CSA-AKI, the assessment of its severity and prognosis, and the early institution of interventions to prevent or reduce kidney damage. Further studies are needed to determine how to optimize cardiac surgical procedures, CPB parameters, and intraoperative and early postoperative blood pressure and renal blood flow to reduce the risk of CSA-AKI. No pharmacologic strategy has demonstrated clear efficacy in the prevention of CSA-AKI; however, some agents, such as the natriuretic peptide nesiritide and the dopamine agonist fenoldopam, have shown promising results in renoprotection. It remains unclear whether CSA-AKI patients can benefit from the early institution of such pharmacologic agents or the early initiation of renal replacement therapy.

KEYWORDS:

Acute kidney injury; Cardiac surgical procedures; Cardiopulmonary bypass; Renal replacement therapy

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