Perioperative Acute Kidney Injury

Abstract

Acute kidney injury (AKI) is one of the important complications of the perioperative period, and associated with increased risk of chronic kidney disease, renal replacement therapy requirements, increased cost, and risk of mortality. In this overview, we summarized baseline confounders and surgical procedure related risk factors contributing to the perioperative AKI, which may serve as risk scores, improve early diagnosis, contribute to prevention, and early management of AKI. There are immediate needs for context specific clinical prediction scores and novel biomarkers to very early diagnose AKI. Preventive guidance provided by Kidney Disease: Improving Global Outcomes is a helpful practical tool for clinicians. Potential roles of novel biomarkers and their context specific contributions require further exploration and close attention. Perioperative hemodynamics and oxygenation appear to contribute to AKI. Therefore, while their optimization can be recommended, their detailed and context specific roles need further explored. Overall, decreased exposure to nephrotoxic agents is recommended to further decrease the impact of perioperative AKI.

Keywords

• perfusion
• oxygen
• oxygenation
• hypoxia
• oxygen delivery
• blood pressure
• hypotension
• hemoglobin
• acute kidney injury
• creatinine
• lipocalin (ngal)
• hypoxia inducible factor
• kidney disease: improving global outcomes