Preoperative Renal Functional Reserve Predicts Risk of Acute Kidney Injury After Cardiac Operation

Husain‐Syed, Faeq; Ferrari, Fiorenza; Sharma, Aashish; Danesi, Tommaso Hinna; Bezerra, Pércia; López-Giacoman, Salvador; Samoni, Sara; Cal, Massimo de; Corradi, Valentina; Virzì, Grazia Maria; Rosa, Silvia De; Bermejo, M.; Estremadoyro, Carla; Villa, Gianluca; Zaragoza, José J.; Caprara, Carlotta; Brocca, Alessandra; Birk, Horst‐Walter; Walmrath, Hans‐Dieter; Seeger, Werner; Nalesso, Federico; Zanella, Monica; Brendolan, Alessandra; Giavarina, Davide; Salvador, Loris; Bellomo, Rinaldo; Rosner, Mitchell H.; Kellum, John A.; Ronco, Claudio

doi:10.1016/j.athoracsur.2017.12.034

Cited by 88 publications

(73 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In order to overcome this limitation, the quantification of Renal Functional Reserve (RFR), a measure of the kidney's capacity to increase GFR by a combination of nephron recruitment and increases in renal blood flow coupled with hyperfiltration, has been proposed [20][21][22]. Healthy nephrons have the ability to increase filtration rate.…”

Section: Renal Functional Reservementioning

confidence: 99%

“…This physiological mechanism can be used to estimate a global potential nephron recruitment in order to stratify, before surgery, the possibility to tolerate renal injuries and additional loads. It has been estimated that RFR physiologically accounts for over a 30% increase in GFR [20,21]. Such determinations are easily made by determining the difference between GFR measured before and 1-2 h after eating a protein meal [20].…”

Section: Renal Functional Reservementioning

confidence: 99%

See 1 more Smart Citation

Perioperative Acute Kidney Injury: Prevention, Early Recognition, and Supportive Measures

Romagnoli

Ricci

Ronco

2018

Nephron

Self Cite

View full text Add to dashboard Cite

Background: Acute kidney injury (AKI) is a frequent complication of both cardiac and major non-cardiac surgery. AKI is independently associated with morbidity, mortality, and long-term adverse events including chronic kidney disease in postsurgical patients. Since specific treatment options for kidney failure are very limited, early identification, diagnosis, and renal support strategies are key steps to improve patients’ outcome. Summary: According to current Kidney Disease: Improving Global Outcomes (KDIGO) guidelines, AKI diagnosis is based on 2 functional markers, serum creatinine increase and urine output decrease, that are not renal-specific and have important limitations. However, preoperative risk stratification for postoperative AKI and/or early diagnosis after surgery could be the best way to apply preventive or timely supportive therapeutic measures. Clinical prediction scores, renal functional reserve assessment, and new biomarkers of kidney stress (suppression of tumorigenicity-2, insulin-like growth factor binding protein-7, tissue inhibitor metalloproteinase-2) may help the clinicians to identify patients at risk of AKI and that could benefit from the application of nephroprotective bundles suggested by the KDIGO guidelines. In severe AKI patients with oligoanuria and fluid accumulation, renal replacement therapy is the only supportive measure even if mode and timing remain open to investigation. Key messages: Perioperative AKI is an important and underdiagnosed complication. Identifying patients at high risk of AKI and diagnosing AKI early are major goals. Preventive interventions are mainly based on the KDIGO guidelines and bundles. Furthermore, a personalized multidisciplinary approach should always be considered to minimize the progression of disease and the complications related to kidney damage.

show abstract

Section: Renal Functional Reservementioning

confidence: 99%

Section: Renal Functional Reservementioning

confidence: 99%

Perioperative Acute Kidney Injury: Prevention, Early Recognition, and Supportive Measures

Romagnoli

Ricci

Ronco

2018

Nephron

Self Cite

View full text Add to dashboard Cite

show abstract

“…Furthermore, measurement of renal reserve is not yet standardized and therefore rarely performed. At present, renal reserve is measured by determining the difference between the resting and stress GFR from the endogenous creatinine CCr before and after an oral protein load consumed after an 8-h fast and accompanied by adequate oral hydration [9]. Hourly CCr measurements are used and continued for at least 3 h. Consequently, they are subject to the same constraints and limitations as short duration CCr measurements following supervised voiding [5].…”

mentioning

confidence: 99%

“…Hourly CCr measurements are used and continued for at least 3 h. Consequently, they are subject to the same constraints and limitations as short duration CCr measurements following supervised voiding [5]. Nevertheless, a recent study showed that low reserve predicted AKI following cardiac bypass with an AUC of 0.83 (95% CI 0.70-0.96) [9]. This was similar to the immediate postoperative predictive performance of the urinary cell-cycle arrest biomarkers insulin-like growth factor binding protein-7, and tissue inhibitor of metalloproteinase-2, (AUC 0.87 [95% CI 0.79-0.84]) [9].…”

mentioning

confidence: 99%

“…Nevertheless, a recent study showed that low reserve predicted AKI following cardiac bypass with an AUC of 0.83 (95% CI 0.70-0.96) [9]. This was similar to the immediate postoperative predictive performance of the urinary cell-cycle arrest biomarkers insulin-like growth factor binding protein-7, and tissue inhibitor of metalloproteinase-2, (AUC 0.87 [95% CI 0.79-0.84]) [9]. It remains to be seen whether AKI reduces renal reserve, which seems likely if AKI has produced unresolved injury or subclinical CKD.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Assessing Renal Recovery after Acute Kidney Injury: Can Biomarkers Help?

Endre

2018

Nephron

View full text Add to dashboard Cite

While there are no clear definitions of recovery, it is clear that the goals of recovery depend on the severity of acute kidney injury and the clinical context. The degree of renal recovery affects both renal and clinical prognosis. There are presently few guidelines on recovery targets, which range in extent from dialysis independence via normalization of serum creatinine to recovery of renal functional reserve. However, while there are no validated biomarkers for predicting recovery, evidence suggests that both functional and damage biomarkers can aid the assessment of recovery.

show abstract

Recommendations on Acute Kidney Injury Biomarkers From the Acute Disease Quality Initiative Consensus Conference

et al. 2020

Self Cite

View full text Add to dashboard Cite

IMPORTANCE In the last decade, new biomarkers for acute kidney injury (AKI) have been identified and studied in clinical trials. Guidance is needed regarding how best to incorporate them into clinical practice. OBJECTIVE To develop recommendations on AKI biomarkers based on existing data and expert consensus for practicing clinicians and researchers. EVIDENCE REVIEW At the 23rd Acute Disease Quality Initiative meeting, a meeting of 23 international experts in critical care, nephrology, and related specialties, the panel focused on 4 broad areas, as follows: (1) AKI risk assessment; (2) AKI prediction and prevention; (3) AKI diagnosis, etiology, and management; and (4) AKI progression and kidney recovery. A literature search revealed more than 65 000 articles published between 1965 and May 2019. In a modified Delphi process, recommendations and consensus statements were developed based on existing data, with 90% agreement among panel members required for final adoption. Recommendations were graded using the Grading of Recommendations, Assessment, Development and Evaluations system. FINDINGS The panel developed 11 consensus statements for biomarker use and 14 research recommendations. The key suggestions were that a combination of damage and functional biomarkers, along with clinical information, be used to identify high-risk patient groups, improve the diagnostic accuracy of AKI, improve processes of care, and assist the management of AKI. CONCLUSIONS AND RELEVANCE Current evidence from clinical studies supports the use of new biomarkers in prevention and management of AKI. Substantial gaps in knowledge remain, and more research is necessary.

show abstract

Preoperative Renal Functional Reserve Predicts Risk of Acute Kidney Injury After Cardiac Operation

Cited by 88 publications

References 27 publications

Perioperative Acute Kidney Injury: Prevention, Early Recognition, and Supportive Measures

Perioperative Acute Kidney Injury: Prevention, Early Recognition, and Supportive Measures

Assessing Renal Recovery after Acute Kidney Injury: Can Biomarkers Help?

Recommendations on Acute Kidney Injury Biomarkers From the Acute Disease Quality Initiative Consensus Conference

Contact Info

Product

Resources

About