Optimization of kidney function in cardiac surgery patients with intra-abdominal hypertension: expert opinion

Area of Science:

• Nephrology
• Cardiology
• Critical Care Medicine

Background:

• Cardiac surgery-associated acute kidney injury (CSA-AKI) affects up to 42% of patients.
• Intra-abdominal hypertension (IAH) is an often-overlooked multifactorial cause of CSA-AKI.
• IAH decreases cardiac output and compresses renal vasculature and parenchyma, leading to low abdominal perfusion pressure.

Purpose of the Study:

• To review current evidence on the pathophysiology, diagnosis, and therapy of IAH and abdominal compartment syndrome (ACS) in the context of AKI.
• To highlight the link between low abdominal perfusion pressure and CSA-AKI.
• To provide expert opinion on managing IAH and ACS in cardiac surgery patients.

Main Methods:

• Literature review of recent studies on IAH, ACS, and AKI in cardiac surgery.
• Expert opinion synthesis based on current evidence.
• Analysis of the relationship between abdominal perfusion pressure, IAP, and renal outcomes.

Main Results:

• IAH is frequently observed in cardiac surgery patients.
• Low abdominal perfusion pressure, resulting from IAH, is linked to the occurrence of AKI.
• Understanding IAH pathophysiology is crucial for AKI prevention and management.

Conclusions:

• IAH and ACS are significant contributors to CSA-AKI.
• Monitoring and managing IAP is essential in cardiac surgery patients at risk for AKI.
• Further research is needed to optimize diagnostic and therapeutic strategies for IAH and ACS in this population.