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Published on: November 3, 2023
Acute Kidney Injury after Cardiac Surgery
Thomas M Beaver1, Bhagwan Dass2,3, Ami M Patel4,5
1Division of Cardiovascular Surgery, University of Florida, Gainesville, Florida, USA.
Background:
Cardiac surgery-associated acute kidney injury (CS-AKI) remains a vexing issue. Clinical trials for the prevention of CS-AKI have been disappointing despite enormous initial enthusiasm based on experimental data.
Summary:
The schism in experimental and clinical data has triggered a relook at our understanding of CS-AKI and the experimental and preclinical models. In this review, we discuss the therapeutic targets of major clinical trials.
Key Messages:
The silver lining in the midst is the standardization of anesthetic and perioperative care proposed by national societies. Implementation of the KDIGO bundle is a reasonable option to decrease the incidence of CS-AKI despite lack of proven robust benefits.
Insights
Cardiac surgery-associated acute kidney injury (CS-AKI) is a significant challenge. This review examines therapeutic targets from clinical trials and suggests standardizing care may reduce CS-AKI incidence.
Area of Science:
- Nephrology
- Cardiology
- Critical Care Medicine
Background:
- Cardiac surgery-associated acute kidney injury (CS-AKI) presents a persistent clinical challenge.
- Numerous clinical trials aimed at preventing CS-AKI have yielded disappointing results, contrasting with promising preclinical data.
Purpose of the Study:
- To re-evaluate the understanding of CS-AKI in light of discrepancies between experimental and clinical findings.
- To review the therapeutic targets investigated in major clinical trials for CS-AKI prevention.
Main Methods:
- Literature review of clinical trials and preclinical models related to CS-AKI.
- Analysis of therapeutic targets and outcomes from conducted studies.
Main Results:
- Significant divergence exists between experimental data and clinical trial outcomes for CS-AKI interventions.
- Current therapeutic strategies have not consistently translated experimental success into clinical benefits.
Conclusions:
- A critical reassessment of CS-AKI pathophysiology and relevant models is warranted.
- Standardization of anesthetic and perioperative care, including the KDIGO bundle, offers a pragmatic approach to mitigate CS-AKI incidence, despite limited proven efficacy.
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