title: Preventing acute kidney injury after cardiac surgery.
abstract: OBJECTIVE
  Acute kidney injury (AKI) is a serious complication that significantly increases morbidity, mortality and cost of care after cardiac surgery. In this review we identify the current literature that addresses strategies for renal protection and the prevention of AKI after cardiac surgery.
  
  
  RESULTS
  Even with aggressive medical care and renal replacement therapy (RRT) the morbidity, mortality and cost of postoperative AKI after cardiac surgery is substantial. An emphasis on preventive strategies would therefore appear to be the most cost-effective approach. Recent literature offers hope that as our understanding of the pathogenesis of AKI after cardiac surgery continues to improve, new directions for the prevention and amelioration of AKI will emerge. Approaches to the prevention of postoperative AKI include careful risk stratification of patients, allowing adequate recovery following a prior AKI, consideration of less extensive surgical procedures, avoidance of cardiopulmonary bypass, minimizing injury from radiocontrast dyes or other nephrotoxic agents, and optimizing cardiovascular function and oxygen delivery. Early identification of AKI and prompt, judicious application of RRT may also improve outcomes. Interest in pharmacologic renoprotection is currently directed toward statins and sodium bicarbonate.
  
  
  CONCLUSIONS
  Postoperative AKI is a serious complication after cardiac surgery. Therapeutic interventions and RRT have limited influence on the outcome of AKI, and a preventive strategy remains the mainstay to attenuate its impact.
authors.affiliation: Department of Anesthesiology, College of Physicians & Surgeons of Columbia University, New York, New York 10032, USA.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Coleman
authors.forename: Shahzad
authors.initials: S
authors.lastname: Shaefi
authors.forename: Robert N
authors.initials: RN
authors.lastname: Sladen
mesh_terms: D058186:Acute Kidney Injury / Q000145:classification / Q000175:diagnosis / Q000517:prevention & control*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects; D042241:Early Diagnosis; D018818:Fenoldopam / Q000494:pharmacology; D005947:Glucose / Q000378:metabolism; D006461:Hemolysis; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000494:pharmacology; D007668:Kidney / Q000187:drug effects; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects; D011183:Postoperative Complications / Q000517:prevention & control*; D017582:Renal Replacement Therapy; D012307:Risk Factors
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D018818:Fenoldopam; D005947:Glucose