Prediction and Prevention of Acute Kidney Injury after Cardiac Surgery
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Published on: November 3, 2023
Su Rin Shin1, Won Ho Kim2, Dong Joon Kim3
1Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon 51353, Republic of Korea; Department of Internal Medicine, College of Medicine, Kangwon National University, Chuncheon 24341, Republic of Korea.
Insights
Acute kidney injury after cardiac surgery (CS-AKI) is common and serious. Current preventive strategies lack consistent benefits, highlighting the need for further research into effective interventions.
Area of Science:
- Cardiology
- Nephrology
- Perioperative Medicine
Background:
- Acute kidney injury after cardiac surgery (CS-AKI) affects 33%–94% of patients, leading to significant morbidity and mortality.
- CS-AKI is multifactorial, influenced by various perioperative management aspects.
- Existing risk factors, scores, and biomarkers aid in diagnosis, but effective prevention remains challenging.
Purpose of the Study:
- To review current evidence on risk factors for CS-AKI.
- To summarize updated preventive strategies for CS-AKI.
- To discuss the efficacy of goal-directed therapy and pharmacologic agents in CS-AKI prevention.
Main Methods:
- Literature review of studies on CS-AKI risk factors.
- Analysis of research on preventive interventions, including goal-directed therapy and pharmacologic agents.
- Synthesis of current evidence on CS-AKI etiology and management.
Main Results:
- No single preventive intervention has demonstrated definite and persistent benefit in reducing CS-AKI incidence.
- Goal-directed therapy shows potential as a preventive strategy.
- Evidence for pharmacologic agents in treating or preventing CS-AKI is conflicting and limited.
Conclusions:
- Effective prevention of CS-AKI remains a critical challenge in cardiac surgery.
- Further research is needed to identify and validate interventions with consistent efficacy.
- A comprehensive understanding of risk factors and tailored preventive strategies are essential for improving patient outcomes.
Abstract:
The incidence of acute kidney injury after cardiac surgery (CS-AKI) ranges from 33% to 94% and is associated with a high incidence of morbidity and mortality. The etiology is suggested to be multifactorial and related to almost all aspects of perioperative management. Numerous studies have reported the risk factors and risk scores and novel biomarkers of AKI have been investigated to facilitate the subclinical diagnosis of AKI. Based on the known independent risk factors, many preventive interventions to reduce the risk of CS-AKI have been tested. However, any single preventive intervention did not show a definite and persistent benefit to reduce the incidence of CS-AKI. Goal-directed therapy has been considered to be a preventive strategy with a substantial level of efficacy. Many pharmacologic agents were tested for any benefit to treat or prevent CS-AKI but the results were conflicting and evidences are still lacking. The present review will summarize the current updated evidences about the risk factors and preventive strategies for CS-AKI.
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