Cardiac surgery-associated acute kidney injury: risk factors, pathophysiology and treatment

• Published in: Nature reviews. Nephrology Vol. 13; no. 11; pp. 697 - 711
• Main Authors: Wang, Ying, Bellomo, Rinaldo
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.11.2017; Nature Publishing Group
• Subjects: 692/4019/592/75; 692/4022/1585/4; 692/499; 692/53/2422; 692/700/565/545; Acute Kidney Injury - etiology; Acute Kidney Injury - physiopathology; Acute Kidney Injury - therapy; Biological markers; Cardiac Surgical Procedures - adverse effects; Complications and side effects; Glomerular Filtration Rate; Heart surgery; Humans; Identification and classification; Kidney diseases; Kidneys; Medical prognosis; Medicine & Public Health; Nephrology; Postoperative Complications; Prognosis; Renal Replacement Therapy - methods; review-article; Risk factors
• ISSN: 1759-5061; 1759-507X; 1759-507X
• DOI: 10.1038/nrneph.2017.119

Key Points CSA-AKI is the second most common cause of AKI in the intensive care setting and is associated with increased mortality The pathophysiology of CSA-AKI is very complex and probably includes renal ischaemia–reperfusion injury, inflammation, oxidative stress, haemolysis and nephrotoxins To date, no consensus definition for CSA-AKI exists, but the KDIGO criteria for AKI are commonly used in clinical practice To date, no pharmacological or non-pharmacological preventive strategies have been shown to reduce the occurrence of CSA-AKI in clinical trials The management of CSA-AKI requires a multifaceted approach Renal replacement therapy is necessary in 1–5% of patients with CSA-AKI and is associated with poor patient and renal prognosis, both in the short and long-term Cardiac surgery-associated acute kidney injury (CSA-AKI) is the most common complication in adult patients undergoing open heart surgery. In this Review, the authors discuss the definition, epidemiology, pathophysiology and risk factors of CSA-AKI. The authors also explore the use of novel biomarkers of AKI and their potential utility in preventing or treating CSA-AKI. Cardiac surgery-associated acute kidney injury (CSA-AKI) is the most common clinically important complication in adult patients undergoing open heart surgery, and is associated with increased mortality and morbidity. In patients in intensive care units, CSA-AKI is the second most common type of AKI after septic AKI. In this Review, we explore the definition of CSA-AKI, discuss its epidemiology and identify its risk factors. We discuss current theories of the pathophysiology of CSA-AKI and describe its clinical course. Furthermore, we introduce diagnostic tools with particular reference to novel biomarkers of AKI and their potential utility; we analyse currently applied interventions aimed at attenuating AKI in patients undergoing cardiac surgery; and describe evidence from randomized controlled trials aimed at preventing or treating CSA-AKI. Finally, we explore issues in the use of renal replacement therapy, its timing, its intensity and its preferred modalities in patients with CSA-AKI, and we discuss the prognosis of CSA-AKI in terms of patient survival and kidney recovery.