Review

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

  • Nature Reviews Nephrology 13, 697711 (2017)
  • doi:10.1038/nrneph.2017.119
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Abstract

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.

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Acknowledgements

The authors thank M. Gallagher, M. G. Wong and J. Knight for assistance with review of the draft manuscript. Y.W. was supported by a John Chalmers Clinical Research Fellowship (supported by Servier).

Author information

Affiliations

  1. The Renal and Metabolic Division, The George Institute for Global Health, Level 5, 1 King Street, Newtown, New South Wales 2042, Australia.

    • Ying Wang
    •  & Rinaldo Bellomo
  2. Concord Clinical School, The University of Sydney, New South Wales 2139, Australia.

    • Ying Wang
  3. The Sydney Adventist Hospital, Wahroonga, Sydney, New South Wales 2076, Australia.

    • Ying Wang
  4. Intensive Care Unit, The Royal Melbourne Hospital, Parkville, Melbourne, Victoria 3050, Australia.

    • Rinaldo Bellomo
  5. School of Medicine, University of Melbourne, Parkville, Melbourne, Victoria 3010, Australia.

    • Rinaldo Bellomo

Authors

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Contributions

Y.W. researched data for the article, R.B. and Y.W. made substantial contributions to discussions of the content, Y.W. wrote the article and R.B. reviewed and/or edited the manuscript before submission.

Competing interests

The authors declare no competing financial interests.

Corresponding author

Correspondence to Rinaldo Bellomo.

Supplementary information

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  1. 1.

    Supplementary information S1 (table)

    Randomized controlled trials of preventive agents for CSA-AKI