title: Cardiac surgery-associated acute kidney injury.
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.
authors.affiliation: Department of Nephrology, Ospedale San Bortolo, Vicenza, Italy.
authors.forename: Huijuan
authors.initials: H
authors.lastname: Mao
authors.forename: Nevin
authors.initials: N
authors.lastname: Katz
authors.forename: Wassawon
authors.initials: W
authors.lastname: Ariyanon
authors.forename: Lourdes
authors.initials: L
authors.lastname: Blanca-Martos
authors.forename: Zelal
authors.initials: Z
authors.lastname: Adýbelli
authors.forename: Anna
authors.initials: A
authors.lastname: Giuliani
authors.forename: Tommaso Hinna
authors.initials: TH
authors.lastname: Danesi
authors.forename: Jeong Chul
authors.initials: JC
authors.lastname: Kim
authors.forename: Akash
authors.initials: A
authors.lastname: Nayak
authors.forename: Mauro
authors.initials: M
authors.lastname: Neri
authors.forename: Grazia Maria
authors.initials: GM
authors.lastname: Virzi
authors.forename: Alessandra
authors.initials: A
authors.lastname: Brocca
authors.forename: Elisa
authors.initials: E
authors.lastname: Scalzotto
authors.forename: Loris
authors.initials: L
authors.lastname: Salvador
authors.forename: Claudio
authors.initials: C
authors.lastname: Ronco
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control / Q000628:therapy; D015415:Biomarkers; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D006801:Humans; D017582:Renal Replacement Therapy / Q000009:adverse effects; D012307:Risk Factors
chemical_list: D015415:Biomarkers