Acute Kidney Injury Following Cardiac Surgery: Prevention, Diagnosis, and Management

Moss, Emmanuel; Lamarche, Yoan

doi:10.5772/37434

Cited by 6 publications

(9 citation statements)

References 165 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The other marker, urinalysis, can differentiate pre-renal from renal failure in patients with decreased urine output which is very helpful in guiding treatment. Obviously urinalysis is not suitable for prophylactic measures due to its delayed response to renal insult [71] . With regard to eGFR formulas, we know that there is a lag between the renal event and serum creatinine changes that may be as long as 48 h, while we expect to know the occurrence of renal impairment immediately after surgery.…”

Section: Aki Biomarkers Creatinine As a Biomarkermentioning

confidence: 99%

“…Rather than surgery type (valvular, re do, emergency), modifiable procedure-related risk factors include onpump cardiac surgery, CPB nonpulsatile flow and hypothermic CPB. Current data is insufficient to confirm the association between these CPB parameters and the risk of CSA-AKI [2,71] . Other more established CPB-related risk factors are duration of CPB (> 100-120 min), perfu- Najafi M. Creatinine, AKI and cardiac surgery outcome sion pressure, hemodilution during CPB, blood transfusion, hemolysis, most commonly due to cardiotomy suction, and embolism [2,95,96] .…”

Section: Intraoperative Risk Factorsmentioning

confidence: 99%

“…However, its variations are not specific, especially during cardiac surgery with cardiopulmonary bypass (CPB), and unavoidable hemodynamic changes, due to medications, such as diuretics, mannitol and other fluids, and possible measures such as ultrafiltration. In addition, the well-known term of non-oliguric renal failure denotes that normal urine output does not guarantee normal renal function [70,71] . The other marker, urinalysis, can differentiate pre-renal from renal failure in patients with decreased urine output which is very helpful in guiding treatment.…”

Section: Aki Biomarkers Creatinine As a Biomarkermentioning

confidence: 99%

“…Other factors such as the need for preoperative intra-aortic balloon pump and pulmonary rales have been noted in studies. However, the most predictive risk factor has consistently been preoperative renal dysfunction [2,71] . Thakar et al [14] developed a risk index for predicting the need for dialysis after cardiac surgery based on preoperative factors.…”

Section: Preoperative Risk Factorsmentioning

confidence: 99%

“…Risk factors for increased level of serum creatinine and the development of AKI have been widely studied [10,71] . There are two main groups of risk factors: preoperative and intraoperative.…”

Section: Risk Factors For High Perioperative Serum Creatininementioning

confidence: 99%

See 4 more Smart Citations

Serum creatinine role in predicting outcome after cardiac surgery beyond acute kidney injury

Najafi

2014

WJC

View full text Add to dashboard Cite

Serum creatinine is still the most important determinant in the assessment of perioperative renal function and in the prediction of adverse outcome in cardiac surgery. Many biomarkers have been studied to date; still, there is no surrogate for serum creatinine measurement in clinical practice because it is feasible and inexpensive. High levels of serum creatinine and its equivalents have been the most important preoperative risk factor for postoperative renal injury. Moreover, creatinine is the mainstay in predicting risk models and risk factor reduction has enhanced its importance in outcome prediction. The future perspective is the development of new definitions and novel tools for the early diagnosis of acute kidney injury largely based on serum creatinine and a panel of novel biomarkers.

show abstract

Section: Aki Biomarkers Creatinine As a Biomarkermentioning

confidence: 99%

Section: Intraoperative Risk Factorsmentioning

confidence: 99%

Section: Aki Biomarkers Creatinine As a Biomarkermentioning

confidence: 99%

Section: Preoperative Risk Factorsmentioning

confidence: 99%

Section: Risk Factors For High Perioperative Serum Creatininementioning

confidence: 99%

See 3 more Smart Citations

Serum creatinine role in predicting outcome after cardiac surgery beyond acute kidney injury

Najafi

2014

WJC

View full text Add to dashboard Cite

show abstract

Erythropoietin administration for prevention of cardiac surgery-associated acute kidney injury: a meta-analysis of randomized controlled trials

Tie

Luo

Lin

et al. 2014

Eur J Cardiothorac Surg

View full text Add to dashboard Cite

The effect of erythropoietin (EPO) on the prevention of cardiac surgery-associated acute kidney injury (CSA-AKI) is controversial. Therefore, we undertook the meta-analysis of randomized controlled trials (RCTs) to assess the efficacy and safety of EPO on the prevention of CSA-AKI in adult patients and to explore whether risk factors for AKI could explain the inconsistent effects. PubMed and EMbase databases were searched to identify eligible RCTs. The meta-analysis was performed with fixed- or random-effects models according to the heterogeneity, and the subgroup analysis stratiﬁed by risk factors for AKI was carried out. Five RCTs involving 423 patients were included. Overall, EPO administration was not associated with a reduced incidence of CSA-AKI [relative risk (RR): 0.64, 95% confidence interval (CI): 0.35-1.16], with a moderate heterogeneity (I(2) = 67.4%, heterogeneity P = 0.02). Subgroup analysis showed that, in patients without high risk factors for AKI, EPO administration could significantly reduce the incidence of CSA-AKI (RR: 0.38, 95% CI: 0.24-0.61), intensive care unit length of stay [standardized mean difference (SMD): -0.54, 95% CI: -1.05 to -0.04] and hospital length of stay (SMD: -0.48, 95% CI: -0.94 to -0.02). The test of heterogeneity was not significant in the two subgroups. EPO administration could significantly reduce the incidence of CSA-AKI, but not in patients with high risk factors for AKI. Substantial heterogeneity across trials could be attributed to high risk factors for AKI. However, our findings should be interpreted cautiously because of the limited studies included, and high-quality RCTs are warranted.

show abstract

Renal ultrasound provides low utility in evaluating cardiac surgery associated acute kidney injury

Young

Crawford

Suarez‐Pierre

et al. 2017

J Cardiothorac Surg

View full text Add to dashboard Cite

BackgroundRenal ultrasonography is part of the algorithm in assessing acute kidney injury (AKI). The purpose of this study was to assess the clinical utility of renal US in postoperative cardiac patients who develop AKI.MethodsWe conducted a retrospective study of 90 postoperative cardiac surgery patients at a single institution from 1/19/2010 to 3/19/2016 who underwent renal US for AKI. We reviewed provider documentation to determine whether renal US changed management. We defined change as: administration of crystalloid or colloid, addition of inotropic or vasopressor, or procedural interventions on the renal system.ResultsMean age of study patients was 68 ± 13 years. 48/90 patients (53.3%) had pre-existing chronic kidney disease of varying severity. 48 patients (53.3%) had normal renal US with incidental findings and 31 patients (34.4%) had US evidence of medical kidney disease. 10 patients (11.1%) had limited US results due to poor visualization and 1 patient (1.1%) had mild right-sided hydronephrosis. No patients were found to have obstructive uropathy or renal artery stenosis. Clinical management was altered in only 4/90 patients (4.4%), which included 3 patients that received a fluid bolus and 1 patient that received a fluid bolus and inotropes. No vascular or urologic procedures resulted from US findings.ConclusionAlthough renal ultrasound is often utilized in the work-up of AKI, our study shows that renal US provides little benefit in managing postoperative cardiac patients. This diagnostic modality should be scrutinized rather than viewed as a universal measure in the cardiac surgery population.

show abstract

Acute Kidney Injury Following Cardiac Surgery: Prevention, Diagnosis, and Management

Cited by 6 publications

References 165 publications

Serum creatinine role in predicting outcome after cardiac surgery beyond acute kidney injury

Serum creatinine role in predicting outcome after cardiac surgery beyond acute kidney injury

Erythropoietin administration for prevention of cardiac surgery-associated acute kidney injury: a meta-analysis of randomized controlled trials

Renal ultrasound provides low utility in evaluating cardiac surgery associated acute kidney injury

Contact Info

Product

Resources

About