title: Cardiac surgery-associated acute kidney injury.
abstract: Acute kidney injury develops in up to 30% of patients who undergo cardiac surgery, with up to 3% of patients requiring dialysis. The requirement for dialysis after cardiac surgery is associated with an increased risk of infection, prolonged stay in critical care units and long-term need for dialysis. The development of acute kidney injury is independently associated with substantial short- and long-term morbidity and mortality. Its pathogenesis involves multiple pathways. Haemodynamic, inflammatory, metabolic and nephrotoxic factors are involved and overlap each other leading to kidney injury. Clinical studies have identified predictors for cardiac surgery-associated acute kidney injury that can be used effectively to determine the risk for acute kidney injury in patients undergoing cardiac surgery. High-risk patients can be targeted for renal protective strategies. Nonetheless, there is little compelling evidence from randomized trials supporting specific interventions to protect or prevent acute kidney injury in cardiac surgery patients. Several strategies have shown some promise, including less invasive procedures in those at greatest risk, natriuretic peptide, fenoldopam, preoperative hydration, preoperative optimization of anaemia and postoperative early use of renal replacement therapy. The efficacy of larger-scale trials remains to be confirmed.
authors.affiliation: Department of Anesthesia and Pain Medicine, University Health Network, Toronto General Hospital, Toronto, ON, Canada.
authors.forename: Marc
authors.initials: M
authors.lastname: Vives
authors.forename: Duminda
authors.initials: D
authors.lastname: Wijeysundera
authors.forename: Nandor
authors.initials: N
authors.lastname: Marczin
authors.forename: Pablo
authors.initials: P
authors.lastname: Monedero
authors.forename: Vivek
authors.initials: V
authors.lastname: Rao
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000209:etiology* / Q000378:metabolism / Q000401:mortality / Q000628:therapy; D015415:Biomarkers / Q000378:metabolism; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D042241:Early Diagnosis; D006801:Humans; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers
keywords: Acute kidney injury; Cardiac surgery; Perioperative complications; Prediction; Prevention; Therapy