Abstract
Acute kidney injury (AKI) is associated with increased morbidity and mortality. Although there are many causes of AKI, it is known that patients undergoing high-risk surgery are known to be at significant risk. Although much effort has centred on the minimum arterial pressure needed to maintain renal perfusion, this tends to be based on relatively crude measures such as the mean arterial pressure (MAP), which is widely used as an index for the optimal blood pressure. The rationale behind maintaining MAP is to provide adequate organ perfusion, although this is difficult to assess other than by applying crude end-points. Recent studies have examined the progression of AKI as defined by the KDIGO criteria in terms of time-weighted average values for premorbid and within-ICU haemodynamic pressure-related parameters. Although principally performed on patients who had undergone cardiovascular surgery and who were on vasopressor support, some interesting results were obtained suggesting that crude MAP may not be an adequate target in AKI. In patients with AKI progression, greater observed deficits in mean perfusion pressure, diastolic arterial perfusion, and diastolic perfusion pressures were observed. This study may highlight potential modifiable risk factors for the prevention of progression of AKI, and hopefully translate into improved outcomes.
Highlights
Acute kidney injury (AKI) is associated with increased morbidity and mortality
The kidneys account for less than 5% of our total body weight and yet receive about 25% of our cardiac output. It is of no surprise, that targeting adequate renal perfusion is considered a potential factor for modifying the risk of acute kidney injury (AKI)
The risk of AKI varies depending on aetiology, but it is well established that high-risk surgery, in particular cardiovascular surgery, is associated with an increased threat of AKI
Summary
Acute kidney injury (AKI) is associated with increased morbidity and mortality. there are many causes of AKI, it is known that patients undergoing high-risk surgery are known to be at significant risk. The preservation or improvement of renal perfusion may be achieved through increasing cardiac output by fluid resuscitation, inotropic drugs, renal vasodilators, or systemic vasopressors that all “redirect” blood flow to the kidney.
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