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Update on Perioperative Acute Kidney Injury
Alexander Zarbock1, Jay L Koyner2, Eric A J Hoste3
1From the Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany.
Anesthesia and Analgesia
|August 24, 2018
Summary
Perioperative acute kidney injury (AKI) is a serious complication. Preventive strategies, including hemodynamic optimization and avoiding nephrotoxins, can reduce AKI incidence in high-risk surgical patients.
Area of Science:
- Nephrology
- Anesthesiology
- Critical Care Medicine
Background:
- Perioperative acute kidney injury (AKI) is a frequent complication, increasing patient morbidity and mortality.
- AKI is diagnosed using urine output and serum creatinine levels, but novel biomarkers may offer earlier detection.
- Surgical procedures, comorbidities (CKD, CHF), and perioperative medications (diuretics, contrast, nephrotoxins) are key risk factors.
Purpose of the Study:
- To review the epidemiology and pathophysiology of surgery-associated AKI.
- To highlight the significance of intraoperative oliguria in AKI development.
- To emphasize effective preventive strategies for perioperative AKI.
Main Methods:
- Review of current literature on perioperative AKI.
- Discussion of diagnostic criteria and novel biomarkers.
- Analysis of risk factors and preventive measures based on KDIGO guidelines.
Main Results:
- Intraoperative hypotension and specific comorbidities significantly increase AKI risk.
- Implementing preventive bundles (hemodynamic optimization, volume management, avoiding nephrotoxins) has shown success in reducing AKI.
- Remote ischemic preconditioning is an emerging strategy for AKI prevention.
Conclusions:
- Perioperative AKI is a significant concern requiring proactive management.
- Optimizing patient hemodynamics and judicious use of fluids and nephrotoxic agents are crucial.
- Evidence supports the implementation of preventive strategies to mitigate AKI incidence in high-risk surgical populations.
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