Prevention of cardiac surgery-associated acute kidney injury

Cardiac surgery-associated acute kidney injury (CSA-AKI) is a frequently occurring complication. It carries the risks of increasing mortality and development of chronic kidney disease. The complex pathophysiologic mechanisms still remain unexplained to a large extent. As a result, there is a considerable lack of sufficient therapeutic strategies with renal replacement therapy still representing the cornerstone for the treatment of severe AKI.

The identification of patients at high risk for the development of CSA-AKI and the implementation of new biomarkers are the initial steps to be taken toward the prevention of AKI. The Kidney Disease: Improving Global Outcomes guidelines make appropriate recommendations to alleviate the risk of AKI, including the avoidance of nephrotoxins, the application of certain therapeutic measures for rapid initial hemodynamic stabilization and tight control of blood glucose levels. Complement-balanced crystalloids should be used instead of physiologic saline solutions to reduce the occurrence of CSA-AKI. Moreover, several recent studies have demonstrated protective effects as well as improved patient outcomes of remote ischemic preconditioning in high-risk patients. On the other hand, up to now, the perioperative use of statins for renal protection lacks the scientific basis.

The identification of high-risk patients for AKI and the adherence to the Kidney Disease: Improving Global Outcomes guidelines constitute the mainstays in the management of CSA-AKI. It is of paramount importance to always maintain a sufficient perfusion pressure throughout the perioperative period. In patients at high risk, the use of new biomarkers and remote ischemic preconditioning should be considered.