Acute Kidney Injury following Cardiopulmonary Bypass: A Challenging Picture.

Dianxiao Liu,Yang Yang,Wei Hu,Zhi Yang,Fangjian Ma,Baohui Liu,Zhenxing Liang,Jayeeta Ghose

doi:10.1155/2021/8873581

Abstract

Recent studies have recognized several risk factors for cardiopulmonary bypass- (CPB-) associated acute kidney injury (AKI). However, the lack of early biomarkers for AKI prevents practitioners from intervening in a timely manner. We reviewed the literature with the aim of improving our understanding of the risk factors for CPB-associated AKI, which may increase our ability to prevent or improve this condition. Some novel early biomarkers for AKI have been introduced. In particular, a combinational use of these biomarkers would be helpful to improve clinical outcomes. Furthermore, we discuss several interventions that are aimed at managing CPB-associated AKI, may increase the effect of renal replacement therapy (RRT), and may contribute to preventing CPB-associated AKI. Collectively, the conclusions of this paper are limited by the availability of clinical trial evidence and conflicting definitions of AKI. A guideline is urgently needed for CPB-associated AKI.

Highlights

Cardiopulmonary bypass (CPB) is a form of extracorporeal circulation that temporarily replaces the function of the heart and lungs during surgery to maintain the circulation of blood and oxygen in the patient, which has benefited thousands of patients since its introduction nearly 60 years ago [1, 2]
We reviewed the literature with the aim of improving our understanding of the risk factors for cardiopulmonary bypass- (CPB-)associated acute kidney injury (AKI), which may increase our ability to prevent or improve this condition
We discuss several interventions that are aimed at managing CPB-associated AKI, may increase the effect of renal replacement therapy (RRT), and may contribute to preventing CPB-associated AKI

Summary

Introduction

Cardiopulmonary bypass (CPB) is a form of extracorporeal circulation that temporarily replaces the function of the heart and lungs during surgery to maintain the circulation of blood and oxygen in the patient, which has benefited thousands of patients since its introduction nearly 60 years ago [1, 2]. AKI occurs in 18.2% to 30% of patients who undergo CPB surgery [7, 9,10,11] and is an important predictor of morbidity and mortality after cardiac surgery [12,13,14,15]. In patients undergoing CPB, AKI is associated with poor outcomes, prolonged hospital stays, Oxidative Medicine and Cellular Longevity increased mortality, and stroke [6,7,8, 21, 22]. An estimate of the variation in the risk factors associated with clinical outcomes is needed to contribute to the prevention of CPB-associated AKI [7]. We present a review of the methods currently used to manage AKI following CPB, including RRT and other interventions. This review should contribute to the prevention and management of CPB-associated AKI

Risk Factors for Acute Renal Dysfunction following Cardiopulmonary Bypass

Renal Replacement Therapy

Other Interventions

Further Perspectives

Findings

Conclusions