Cardiac Surgery-Associated Acute Kidney Injury

Area of Science:

• Nephrology
• Cardiology
• Critical Care Medicine

Background:

• Acute kidney injury (AKI) is a frequent and severe complication following cardiac surgery, significantly increasing patient morbidity and mortality.
• The Kidney Disease Improving Global Outcomes (KDIGO) criteria, based on serum creatinine and urine output, are standard for classifying cardiac surgery-associated AKI (CSA-AKI).
• Numerous pre-, intra-, and postoperative factors contribute to CSA-AKI development, necessitating early identification and intervention.

Purpose of the Study:

• To provide a comprehensive review of cardiac surgery-associated AKI (CSA-AKI).
• To discuss the pathogenesis, risk factors, diagnostic challenges, and emerging biomarkers for CSA-AKI.
• To outline current and future strategies for prevention and management of CSA-AKI.

Main Methods:

• Comprehensive literature review focusing on CSA-AKI.
• Analysis of current diagnostic criteria and their limitations, particularly serum creatinine's accuracy in the perioperative setting.
• Evaluation of existing and novel biomarkers for AKI detection.

Main Results:

• Serum creatinine is an unreliable marker for kidney function in the perioperative period of cardiothoracic surgery.
• There is a critical need for more accurate biomarkers to reflect AKI pathophysiology.
• The tissue inhibitor of metalloproteinase-2 and insulin-like growth factor binding protein 7 ratio is one of the few biomarkers with acceptable sensitivity and specificity, though others are still needed.

Conclusions:

• Effective management of CSA-AKI requires addressing its complex risk factors and improving diagnostic accuracy.
• Development and validation of sensitive and specific biomarkers are essential for early CSA-AKI diagnosis and timely intervention.
• A multidisciplinary approach encompassing prevention, early diagnosis, and tailored treatment is vital to mitigate the impact of CSA-AKI.