Acute kidney injury in cardiac surgery

ABSTRACT

Acute kidney injury is a common and serious complication after major cardiovascular surgery and is independently associated with poor short- and long-term outcomes. The pathogenesis of cardiac surgery-associated acute kidney injury is complex and involves multiple pathways including hemodynamic, inflammatory, metabolic and nephrotoxic factors. Three definitions of acute kidney injury based on serum creatinine and urine output (RIFLE, AKIN, and KDIGO criteria) have been proposed and validated. Several novel biomarkers of acute kidney injury have been developed to facilitate the subclinical diagnosis of acute kidney injury, as well as the better risk stratification of patients. Despite the high-quality research conducted in this field to date, there is very little evidence supporting specific interventions to treat acute kidney injury in patients undergoing cardiovascular surgery. Thus, early identification of high-risk patients and preventing cardiac surgery-associated acute kidney injury by mitigating risk factors or avoiding renal insults remains the mainstay of management. Although some strategies have shown promising results in renoprotection, further large randomized trials are needed to confirm the benefit of such approaches.