title: Mending a broken heart but breaking the kidney.
abstract: The incidence of acute kidney injury (AKI) is a frequent and serious complication of cardiac surgery. In 2013, 95% of cardiac surgical procedures performed in Australia and New Zealand used cardiopulmonary bypass (CPB). AKI following CPB is well known, yet the perioperative factors contributing to its development are incompletely understood. AKI following CPB has significant implications on both short-term and long-term outcomes. The techniques for conducting CPB have evolved, moving towards evidence-based practice; however, there is still no generally accepted definition of optimal perfusion and its conduct. This review examines the current incidence of AKI following cardiac surgery and the short-term and longer-term effects of AKI on morbidity and mortality. The purpose of this review is to discuss the perioperative risk factors related to CPB and their contribution to the development of AKI. This review will also discuss outcomes in regard to off-pump cardiac surgery, the role of remote ischaemic preconditioning on AKI and outcomes in patients with chronic renal failure undergoing cardiac surgery.
authors.affiliation: Department of Cardiac Surgery Research and Perfusion, Cardiac and Thoracic Surgical Unit, Flinders Medical Centre, Adelaide, South Australia, Australia.|School of Medicine, Flinders University, Adelaide, South Australia, Australia.
authors.forename: Annette L
authors.initials: AL
authors.lastname: Mazzone
authors.affiliation: Department of Cardiac Surgery Research and Perfusion, Cardiac and Thoracic Surgical Unit, Flinders Medical Centre, Adelaide, South Australia, Australia.|School of Medicine, Flinders University, Adelaide, South Australia, Australia.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Baker
authors.affiliation: School of Medicine, Flinders University, Adelaide, South Australia, Australia. jonathan.gleadle@health.sa.gov.au.|Department of Renal Medicine, Flinders Medical Centre, Adelaide, South Australia, Australia. jonathan.gleadle@health.sa.gov.au.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Gleadle
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology / Q000209:etiology; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods; D006801:Humans; D015994:Incidence; D019194:Ischemic Preconditioning / Q000379:methods; D000069451:Long Term Adverse Effects / Q000453:epidemiology / Q000517:prevention & control*; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D012307:Risk Factors; D016896:Treatment Outcome
keywords: acute kidney injury; cardiopulmonary bypass