Diagnosis, pathophysiology and preventive strategies for cardiac surgery-associated acute kidney injury: a narrative review

Yu, Ying; Li, Chenning; Zhu, Shuainan; Jin, Lin; Hu, Yan; Ling, Xiaomin; Guo, Kefang

doi:10.1186/s40001-023-00990-2

Cited by 22 publications

(14 citation statements)

References 157 publications

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“…Intraoperative ischemic injury is mainly related to hemodynamic instability, involving patient activities, changes in infusion rates, administration of new drugs, venous/arterial catheterization for monitoring, fluid infusion, anesthesia induction, mechanical ventilation, and other factors that may induce hypotension. [24,25] Several meta-analyses have explored the diagnostic value of numerous biomarkers for AKI. For instance, Ho et al reported that KIM-1 demonstrated the highest predictive value for postoperative AKI (AUROC, 0.72), which aligns with our study findings.…”

Section: Discussionmentioning

confidence: 99%

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Comparing diagnostic accuracy of biomarkers for acute kidney injury after major surgery: A PRISMA systematic review and network meta-analysis

Lan,

Liu,

Yang

et al. 2023

Medicine

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Background: The timely identification of patients at risk of acute kidney injury (AKI), along with early prevention, real-time monitoring, and prompt intervention, plays a crucial role in enhancing patient prognosis after major surgery. Methods: We conducted a comprehensive search across multiple databases, including Web of Science, EMBASE, MEDLINE, China National Knowledge Infrastructure, and Cochrane Library. Each study’s risk of bias was independently evaluated as low, moderate, or high, utilizing criteria adapted from Quality Assessment of Diagnostic Accuracy Studies 2. The analysis was performed using STATA V.17.0 and R software V.3.4.1. Diagnostic tests were ranked based on the dominance index. We performed meta-analyses to calculate odds ratios (ORs) and 95% confidence intervals (CIs) individually. We then carried out a network meta-analysis to compare the performances of these biomarkers. Results: Fifteen studies were included in this analysis. The meta-analysis findings revealed that among all the biomarkers assessed, serum cystatin C (s-CysC) (hierarchical summary receiver operating characteristic curve [HSROC] 82%, 95% CI 0.78–0.85) exhibited the highest HSROC value. The network meta-analysis demonstrated that urinary kidney injury molecule-1 (u-KIM-1) and s-CysC displayed relatively higher sensitivity and specificity, respectively. In subgroup analyses, u-KIM-1 in the urine output (OU) group (OR 303.75, 95% CI 3.39–1844.88), s-CysC in the non-OU group (OR 10.31, 95% CI 3.09–26.2), interleukin-18 in the noncardiac surgery group (OR 46.20, 95% CI 0.48–307.68), s-CysC in the cardiac group (OR 12.42, 95% CI 2.9–35.86), u-KIM-1 in the retrospective group (OR 243.00, 95% CI 1.73–1582.11), and s-CysC in the prospective group (OR 8.35, 95% CI 2.34–21.15) had the best diagnostic accuracy. However, it is important to note that existing publication bias may reduce the reliability of the above-mentioned results. Conclusion: The biomarker of s-CysC has the highest HSROC value to predicting acute kidney injury after major surgery in meta-analysis and relatively higher specificity in network meta-analyses. u-KIM-1 exhibited relatively higher sensitivity, with best diagnostic accuracy in the OU and retrospective group in the subgroup analysis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Comparing diagnostic accuracy of biomarkers for acute kidney injury after major surgery: A PRISMA systematic review and network meta-analysis

Lan,

Liu,

Yang

et al. 2023

Medicine

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“…In the case of fluid excess, hemofiltration should also be targeted to provide an adequate fluid balance in the post-CPB period. Intraoperative hypovolemia should be avoided though, as it has a proven detrimental impact on kidney function [115,116]. A further significant benefit of hemofiltration during the CPB is osmotic load and metabolite removal.…”

Section: Fluid Balance and Osmotic Regulationmentioning

confidence: 99%

Alterations to Kidney Physiology during Cardiopulmonary Bypass—A Narrative Review of the Literature and Practical Remarks

Udzik,

Pacholewicz,

Biskupski

et al. 2023

JCM

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Introduction: According to different authors, cardiac surgery-associated acute kidney injury (CSA-AKI) incidence can be as high as 20–50%. This complication increases postoperative morbidity and mortality and impairs long-term kidney function in some patients. This review aims to summarize current knowledge regarding alterations to renal physiology during cardiopulmonary bypass (CPB) and to discuss possible nephroprotective strategies for cardiac surgeries. Relevant sections: Systemic and renal circulation, Vasoactive drugs, Fluid balance and Osmotic regulation and Inflammatory response. Conclusions: Considering the available scientific evidence, it is concluded that adequate kidney perfusion and fluid balance are the most critical factors determining postoperative kidney function. By adequate perfusion, one should understand perfusion with proper oxygen delivery and sufficient perfusion pressure. Maintaining the fluid balance is imperative for a normal kidney filtration process, which is essential for preserving the intra- and postoperative kidney function. Future directions: The review of the available literature regarding kidney function during cardiac surgery revealed a need for a more holistic approach to this subject.

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“…[3] Moreover, AKI has become a major public health problem in the world. [4] More than 2 million heart surgeries are performed worldwide each year [5] ,The incidence of acute renal injury (CSA-AKI) after cardiac surgery is as high as 40%, which is the main cause of AKI, and about 3% of patients need at least temporary renal replacement therapy (RRT). [6] Therefore, early screening of CS-AKI patients will help to reduce perioperative mortality, reduce ICU hospitalization days, and reduce medical expenses.…”

Section: Introductionmentioning

confidence: 99%

Plasma-derived exosomal miR-184 and miR-6766-3p as promising diagnostic biomarkers for early detection of children’s cardiac surgery-associated acute kidney injury

Liu,

Bai,

Yuan

et al. 2024

Preprint

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Background: There is little known about the contribution of exosomal microRNAs (miRNAs) in the children’s cardiac surgery-associated acute kidney injury (CSA-AKI). This study aimed to find diagnostic biomarkers for predicting CSA-AKI in children. Methods: A prospective observational study was conducted from April 2020 to March 2021.According to the changes of SCR value and urine volume within 48 hours, the children were divided into AKI group and non-AKI group. Serum samples were collected 4 hours after cardiac surgery. Isolation of EVs and extraction of exomiRs from serum samples.Illumina high-throughput sequencing was used to quantify exomiRs and screen candidate miRNAs. Expression levels of candidate miRNAs were validated using droplet digital polymerase chain reaction (ddPCR) . Normal and injuried rats’ kidney tissue were collected for tissue validation. Result: In the pre-experimental stage (4 AKI vs 4 non-AKI), miR-184, miR-4800-3p, miR-203a-3p and miR-6766-3p were selected as candidate genes.In the verification stage (8 AKI vs 12 non-AKI), the expression of miR-184 in AKI group was significantly lower than that in non-AKI group (paired 0.031), and the expression of miR-4800-3p and miR-6766-3p in AKI group was significantly higher than that in non-AKI group (paired 0.01and paired 0.047).There was no significant difference in the expression of miR-203a-3p between the two groups (P > 0.05). The expression of rats’ kidney tissue miR-184 in AKI group was significantly lower than that in the normal group (P=0.044). The area under the curve (AUC) of AKI predicted by miR-184 is 0.7865 and the AUC of miR-6766-3p is 0.7708.Combined with two kinds of miRNA, the area under the curve of AKI is predicted to be 0.8646. Conclusion: The change of exomiRs level in circulatory system occurred in the early stage after cardiac operation, and the changes of miR-184 and miR-6766-3p content in circulatory system could predict CSA-AKI well.

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Diagnosis, pathophysiology and preventive strategies for cardiac surgery-associated acute kidney injury: a narrative review

Cited by 22 publications

References 157 publications

Comparing diagnostic accuracy of biomarkers for acute kidney injury after major surgery: A PRISMA systematic review and network meta-analysis

Comparing diagnostic accuracy of biomarkers for acute kidney injury after major surgery: A PRISMA systematic review and network meta-analysis

Alterations to Kidney Physiology during Cardiopulmonary Bypass—A Narrative Review of the Literature and Practical Remarks

Plasma-derived exosomal miR-184 and miR-6766-3p as promising diagnostic biomarkers for early detection of children’s cardiac surgery-associated acute kidney injury

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