Prevention of cardiac surgery-associated acute kidney injury

Miet Schetz, T. Bove, A. Morelli, S. Mankad, Claudio Ronco, John A. Kellum

Research output: Contribution to journalArticle

Abstract

Numerous strategies have been evaluated to prevent early CSA-AKI. Although correction of hemodynamic problems is paramount, there are no clinical studies that compare different hemodynamic management or monitoring strategies with regard to their effect on kidney function. Pharmacologic strategies including diuretics, different classes of vasodilators and drugs with anti-inflammatory effects such as N-acetyl-cysteine, do not appear to be effective. Most of the studies are underpowered and use physiological rather than clinical endpoints. Further trials are warranted with fenoldopam and nesiritide (rhBNP). Observational and underpowered randomized studies show beneficial renal effects of off-pump technique and avoidance of aortic manipulation. There is very limited evidence for preoperative fluid loading and preemptive RRT Potentially nephrotoxic agents should be used with caution in patients at risk of CSA-AKI. Tranexamic acid or aminocaproic acid should be preferred over aprotinin. No pharmacologic intervention has been adequately tested in the prevention of late CSA-AKI. A single-center study, including a predominance of patients after cardiac surgery, showed a decrease of kidney injury with tight glycemic control.

Original languageEnglish
Pages (from-to)179-189
Number of pages11
JournalInternational Journal of Artificial Organs
Volume31
Issue number2
Publication statusPublished - Feb 2008

Keywords

  • Acute kidney injury
  • Cardiac surgery
  • Prevention

ASJC Scopus subject areas

  • Biophysics

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    Schetz, M., Bove, T., Morelli, A., Mankad, S., Ronco, C., & Kellum, J. A. (2008). Prevention of cardiac surgery-associated acute kidney injury. International Journal of Artificial Organs, 31(2), 179-189.