Cardiac Surgery Associated AKI Prevention Strategies and Medical Treatment for CSA-AKI

Acute kidney injury (AKI) is common after cardiac surgery. To date, there are no specific pharmacological therapies. In this review, we summarise the existing evidence for prevention and management of cardiac surgery-associated AKI and outline areas for future research. Preoperatively, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers should be withheld and nephrotoxins should be avoided to reduce the risk. Intraoperative strategies include goal-directed therapy with individualised blood pressure management and administration of balanced fluids, the use of circuits with biocompatible coatings, application of minimally invasive extracorporeal circulation, and lung protective ventilation. Postoperative management should be in accordance with current KDIGO AKI recommendations.

Automated summary

Acute kidney injury (AKI) is common after cardiac surgery and there are currently no specific pharmacological therapies, prevention and management strategies include preoperative withdrawal of certain drugs and avoidance of nephrotoxic agents, intraoperative goal-directed therapy and use of biocompatible coatings in circuits, postoperative management should follow current KDIGO AKI recommendations.