Update on acute kidney injury after cardiac surgery

Abstract

Objectives: To review the current state of clinical practice and discuss recent advances in the diagnosis and management of acute kidney injury (AKI) in the context of cardiac surgery.

Methods: A review of the published data pertaining to AKI in the setting of cardiac surgery and cardiothoracic surgical critical care medicine was conducted, and the relevant data were synthesized from appropriate interventional and observational study reports.

Results: Significant advances have occurred in the diagnosis of AKI, and consensus has been reported on a system of diagnosis using the serum creatinine and urine output. New biomarkers of injury and function are available that are likely to improve the interval to diagnosis of AKI after cardiac surgery. The adverse effect on outcome of small changes in serum creatinine is appreciated. Novel prevention and rescue therapies are now entering phase I and II studies. Urinary alkalinization was effective in a phase II blinded clinical trial and is now the subject of a multicenter, double-blind, randomized clinical trial of cardiac surgery patients.

Conclusions: In 2011, the field of AKI could be emerging from a period of stagnation that has lasted more than 2 decades. The failure to translate successful animal model interventions to the clinic might have resulted from delays in diagnosis that might now be avoidable with the advent of novel diagnostic biomarkers.