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Technical Refinement of a Bilateral Renal Ischemia-Reperfusion Mouse Model for Acute Kidney Injury Research
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Perioperative renal failure in elderly patients
Johan Mårtensson1, Rinaldo Bellomo
1aDepartment of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia bSection of Anaesthesia and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden cAustralian and New Zealand Intensive Care Research Centre, School of Preventive Medicine and Public Health, Monash University, Melbourne, Victoria, Australia.
Current Opinion in Anaesthesiology
|February 13, 2015
Summary
Perioperative acute kidney injury (AKI) is a growing concern in elderly patients undergoing surgery. Early detection and careful hemodynamic management are crucial to prevent and manage this condition.
Area of Science:
- Nephrology
- Geriatric Medicine
- Surgical Care
Background:
- Elderly patients have diminished renal reserve and comorbidities, increasing susceptibility to perioperative acute kidney injury (AKI).
- Postoperative AKI in the elderly is often underdiagnosed due to factors like reduced creatinine production and immobility.
- The incidence of perioperative AKI is projected to increase with the aging surgical population.
Purpose of the Study:
- To review the epidemiology, pathophysiology, diagnosis, and management of perioperative AKI in elderly patients.
- To highlight the challenges in diagnosing AKI in this vulnerable population.
- To discuss current and future strategies for preventing and treating perioperative AKI.
Main Methods:
- Literature review focusing on perioperative acute kidney injury in the elderly.
- Analysis of diagnostic challenges, including the role of biomarkers.
- Evaluation of current evidence on preventative and therapeutic interventions.
Main Results:
- Elderly patients face a higher risk of AKI due to reduced renal reserve and comorbidities.
- Delayed diagnosis of AKI is common in immobilized elderly patients.
- Evidence for renal vasodilators and remote ischemic preconditioning is conflicting; avoiding hypotension, venous congestion, and fluid overload is key.
- Continuous renal replacement therapy may be indicated for fluid overload unresponsive to diuretics.
Conclusions:
- The rising number of elderly undergoing surgery will increase postoperative AKI incidence.
- Biomarkers are crucial for future AKI treatment strategies.
- Hemodynamic management should prioritize avoiding hypotension and high central venous pressures in elderly surgical patients.
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