article Open Access (green) EN 2014-11-07

AKI Associated with Cardiac Surgery

Robert H. Thiele, James M. Isbell, Mitchell H. Rosner

Clinical Journal of the American Society of Nephrology, Vol. 10, Issue 3, pp. 500–514 (2014)

University of Virginia Health System

DOI: 10.2215/cjn.07830814 PMID: 25376763

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Abstract

Approximately 18% of patients undergoing cardiac surgery experience AKI (on the basis of modern standardized definitions of AKI), and approximately 2%-6% will require hemodialysis. The development of AKI after cardiac surgery portends poor short- and long-term prognoses, with those developing RIFLE failure or AKI Network stage III having an almost 2-fold increase in the risk of death. AKI is caused by a variety of factors, including nephrotoxins, hypoxia, mechanical trauma, inflammation, cardiopulmonary bypass, and hemodynamic instability, and it may be affected by the clinician's choice of fluids and vasoactive agents as well as the transfusion strategy used. The risk of AKI may be ameliorated by avoidance of nephrotoxins, achievement of adequate glucose control preoperatively, and use of goal-directed therapy hemodynamic strategies. Remote ischemic preconditioning is an exciting future strategy, but more work is needed before widespread implementation. Unfortunately, there are no pharmacologic agents known to reduce the risk of AKI or treat established AKI.

Topics

Renal function and acid-base balance 1.00 Acute Kidney Injury Research 1.00 Cardiac Arrest and Resuscitation 1.00

Field: Medicine · Subfield: Nephrology

Keywords

Medicine,Cardiac surgery,Intensive care medicine,Cardiology,Internal medicine

MeSH Terms

Cardiac Surgical ProceduresCardiac Surgical ProceduresCardiac Surgical ProceduresHumansHumansHumansRisk FactorsRisk Factors

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