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Cardiopulmonary Bypass and AKI: AKI Is Bad, So Let's Get Beyond the Diagnosis
1Pediatric Cardiology, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, United States.
Insights
Acute kidney injury (AKI) after cardiopulmonary bypass (CPB) leads to serious long-term health issues. Current treatments are suboptimal, highlighting the need for better therapeutic strategies and multi-center trials.
Area of Science:
- Nephrology
- Cardiovascular Surgery
- Critical Care Medicine
Background:
- Acute kidney injury (AKI) is a frequent and severe complication following cardiopulmonary bypass (CPB).
- Post-CPB AKI is associated with adverse short-term and long-term outcomes, including chronic kidney disease, increased healthcare use, and cardiovascular events.
- Despite advances in understanding and diagnosis, therapeutic options for post-CPB AKI remain limited.
Purpose of the Study:
- To review the challenges in managing and treating acute kidney injury (AKI) after cardiopulmonary bypass (CPB).
- To discuss current best practices and the need for improved therapeutic strategies for post-CPB AKI.
Main Methods:
- Review of existing literature on acute kidney injury (AKI) following cardiopulmonary bypass (CPB).
- Discussion of challenges in clinical trial design for AKI therapies.
- Analysis of current management strategies and best practices.
Main Results:
- Therapeutic options for post-CPB AKI are suboptimal, often limited to supportive care.
- AKI bundles show some benefit, but adherence can be inconsistent.
- Key management strategies include maintaining renal perfusion, avoiding fluid overload, and considering early renal replacement therapy.
Conclusions:
- Effective treatments for post-CPB AKI are lacking.
- Overcoming challenges in clinical trial design is essential for advancing AKI therapy.
- Multi-center trials are crucial to developing effective treatments for this significant complication of CPB.
Abstract:
It is now well-established that AKI is a serious and common complication following cardiopulmonary bypass (CPB) in both children and adults, adverse outcomes may occur in the short term as well as long term, with higher incidence of chronic kidney disease, increased healthcare utilization and higher frequency of cardiovascular events in patients who develop post-CPB AKI. Despite the advances in our understanding of the pathogenesis of the disease and the improvement in diagnostic tools, our therapeutic options have remained suboptimal. There are multiple challenges in designing a clinical therapeutic AKI trial, including a multi-factorial etiology, difficulties with accurate diagnosis of AKI, achievement of adequate study power, and determination of appropriate outcomes. We are often left with "supportive" care. Studies have shown some benefit to AKI bundles, but adherence to bundle guidelines may be suboptimal. Current best practices should include maintenance of adequate renal perfusion pressure and avoidance of fluid overload, with consideration of early renal replacement therapy. Finally, multi-center trials of AKI therapies are crucial to finding treatment for this devastating complication of CPB.
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