Acute Kidney Injury After Cardiac Surgery: A Narrative Review of the Literature

Acute kidney injury (AM) is a common and serious complication of cardiac surgery. It is associated with increased morbidity and mortality. On a population level, the financial impact and overall incremental annual index hospitalization costs associated with AM exceed $1 billion in the United States alone. The pathogenesis is multifaceted and complex. Although novel biomarkers may be useful in detecting AM at an earlier stage, treatment of AM remains elusive. Prevention of AM is still key to the management of AM, and strategies include maintenance of renal perfusion and avoidance of nephrotoxins and blood transfusion-related insults. Dialysis in severe AKI is established, but the optimal modality and dose remains an area of ongoing research. This narrative review assesses the pathophysiology of AM, role of biomarkers, risk assessment, and management in cardiac surgical patients. (C) 2018 Elsevier Inc. All rights reserved.