The epidemiology of cardiac surgery-associated acute kidney injury.
OBJECTIVE
To describe current knowledge on the epidemiology of cardiac surgery-associated acute kidney injury (CSA-AKI) and to formulate recommendations for clinical practice and a research agenda.


METHODS
After a modified Delphi analysis by the Acute Dialysis Quality Initiative (ADQI), 4 questions on the epidemiology of CSA-AKI and recommendations for clinical practice and a research agenda were formulated and addressed.


RESULTS
Existing studies on CSA-AKI use over 35 different definitions for CSA-AKI. In addition, there may be important differences in patient characteristics and procedures. This explains the significant variations in reported incidence. Most studies report on CSA-AKI as defined by the need for renal replacement therapy. However, even small decreases in kidney function are associated with a worsened outcome. The workgroup formulated the recommendation to use the AKIN consensus criteria for AKI. One should differentiate early CSA-AKI, caused by the procedure, and late CSA-AKI, associated with the procedure. There may be different clinical scenarios: acute on chronic CSA-AKI, AKI prior to CS, and AKI occurring post CS. Risk factors should be differentiated between pre-, intra-, and post-CS, and between patient-, process-, and procedure-related. Endpoints should include both short-term and long-term outcomes.


CONCLUSIONS
Existing data on the epidemiology of CSA-AKI are difficult to compare due to variations in definition and patient cohort. A modified Delphi analysis resulted in a series of recommendations for future research on CSA-AKI.
Hoste
E A
EA
Intensive Care Unit, Ghent University Hospital, Gent, Belgium. Eric.Hoste@UGent.be
Cruz
D N
DN
Davenport
A
A
Mehta
R L
RL
Piccinni
P
P
Tetta
C
C
Viscovo
G
G
Ronco
C
C
D058186:Acute Kidney Injury / Q000145:classification / Q000453:epidemiology* / Q000209:etiology; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood / Q000652:urine; D055316:Cystatin C; D015891:Cystatins / Q000097:blood; D003697:Delphi Technique; D005919:Glomerular Filtration Rate; D006801:Humans; D015994:Incidence; D011379:Prognosis; D012307:Risk Factors
C525030:CST3 protein, human; D055316:Cystatin C; D015891:Cystatins; D003404:Creatinine