Acute Kidney Injury Subsequent to Cardiac Surgery.

Area of Science:

• Nephrology
• Cardiology
• Critical Care Medicine

Background:

• Acute kidney injury (AKI) following cardiac surgery is a prevalent complication with significant short- and long-term adverse outcomes.
• Postoperative serum creatinine increases signal intraoperative kidney injury, often occurring during cardiopulmonary bypass (CPB), particularly in susceptible patients.

Purpose of the Study:

• To review the pathophysiology of AKI in cardiac surgery patients.
• To identify patient vulnerabilities and discuss preventative strategies.
• To explore opportunities for reducing AKI incidence through improved perioperative care.

Main Methods:

• Literature review focusing on pathophysiology, risk factors, and prevention strategies for AKI in cardiac surgery.
• Analysis of current definitions of AKI and their impact on perioperative care scrutiny.
• Discussion of preoperative and intraoperative interventions.

Main Results:

• AKI is multifactorial, with intraoperative events during CPB being a key contributor.
• Preoperative patient optimization and intraoperative management, including fluid balance and oxygen delivery, are critical for prevention.
• Newer AKI definitions aid in identifying and mitigating risks.

Conclusions:

• Recognizing and managing preoperative risk factors is essential.
• Optimizing intraoperative practices, such as minimizing hemodilution and maximizing oxygen delivery during CPB, can decrease AKI incidence.
• A comprehensive approach encompassing preoperative checklists and meticulous CPB conduct is vital for AKI prevention.