Cardiac surgery-associated acute kidney injury

By reading this article, you should be able to: Diagnose cardiac surgery-associated acute kidney injury (CSA-AKI) and identify the biomarkers currently available and under investigation. Explain the underlying pathophysiological mechanisms of CSA-AKI. Discuss the risk factors that increase the likelihood of CSA-AKI. Describe the available preventive strategies.Cardiac surgery-associated acute kidney injury (CSA-AKI) describes a decline in kidney function after cardiac surgery.Cardiac surgery-associated AKI is the second leading cause of AKI in patients in the ICU (sepsis is the leading cause). 1 The reported incidence varies from 5% to 40% depending on the type of cardiac surgery, the study group and the definition of AKI. 1-3Among cardiac procedures, the lowest incidence is after isolated coronary artery bypass graft (CABG) surgery, with progressively increased rates after valvular surgery, aortic surgery and heart transplantation. 3Cardiac surgeryassociated AKI is associated with short-term complications, including infections, prolonged ICU stay and an increased risk of cardiovascular complications, such as myocardial infarction, stroke and heart failure. 1 Acute kidney injury is not only associated with chronic kidney disease (CKD) but may also play a direct causal role in its development. 2Patients with CSA-AKI have a five-fold increased risk of developing CKD. 2 Cardiac surgeryassociated AKI is associated with an increased risk of mortality extending up to 10 yrs after cardiac surgery. 1,2s CSA-AKI is common and associated with adverse outcomes, clinicians should be able to identify patients at risk, make an early diagnosis and know what strategies to consider for prevention and treatment.