Advanced search
1 file | 294.16 KB Add to list

Update on perioperative acute kidney injury

(2018) ANESTHESIA AND ANALGESIA. 127(5). p.1236-1245
Author
Organization
Abstract
Acute kidney injury (AKI) in the perioperative period is a common complication and is associated with increased morbidity and mortality. A standard definition and staging system for AKI has been developed, incorporating a reduction of the urine output and/or an increase of serum creatinine. Novel biomarkers may detect kidney damage in the absence of a change in function and can also predict the development of AKI. Several specific considerations for AKI risk are important in surgical patients. The surgery, especially major and emergency procedures in critically ill patients, may cause AKI. In addition, certain comorbidities, such as chronic kidney disease and chronic heart failure, are important risk factors for AKI. Diuretics, contrast agents, and nephrotoxic drugs are commonly used in the perioperative period and may result in a significant amount of in-hospital AKI. Before and during surgery, anesthetists are supposed to optimize the patient, including preventing and treating a hypovolemia and correcting an anemia. Intraoperative episodes of hypotension have to be avoided because even short periods of hypotension are associated with an increased risk of AKI. During the intraoperative period, urine output might be reduced in the absence of kidney injury or the presence of kidney injury with or without fluid responsiveness. Therefore, fluids should be used carefully to avoid hypovolemia and hypervolemia. The Kidney Disease: Improving Global Outcomes guidelines suggest implementing preventive strategies in high-risk patients, which include optimization of hemodynamics, restoration of the circulating volume, institution of functional hemodynamic monitoring, and avoidance of nephrotoxic agents and hyperglycemia. Two recently published studies found that implementing this bundle in high-risk patients reduced the occurrence of AKI in the perioperative period. In addition, the application of remote ischemic preconditioning has been studied to potentially reduce the incidence of perioperative AKI. This review discusses the epidemiology and pathophysiology of surgery-associated AKI, highlights the importance of intraoperative oliguria, and emphasizes potential preventive strategies.
Keywords
ACUTE-RENAL-FAILURE, RANDOMIZED CLINICAL-TRIAL, MAJOR ABDOMINAL-SURGERY, CRITICALLY-ILL PATIENTS, FUROSEMIDE STRESS TEST, HIGH-RISK PATIENTS, CARDIAC-SURGERY, NONCARDIAC SURGERY, FLUID MANAGEMENT, INTENSIVE-CARE

Downloads

  • (...).pdf
    • full text
    • |
    • UGent only
    • |
    • PDF
    • |
    • 294.16 KB

Citation

Please use this url to cite or link to this publication:

MLA
Zarbock, Alexander, Jay L Koyner, Eric Hoste, et al. “Update on Perioperative Acute Kidney Injury.” ANESTHESIA AND ANALGESIA 127.5 (2018): 1236–1245. Print.
APA
Zarbock, A., Koyner, J. L., Hoste, E., & Kellum, J. A. (2018). Update on perioperative acute kidney injury. ANESTHESIA AND ANALGESIA, 127(5), 1236–1245.
Chicago author-date
Zarbock, Alexander, Jay L Koyner, Eric Hoste, and John A Kellum. 2018. “Update on Perioperative Acute Kidney Injury.” Anesthesia and Analgesia 127 (5): 1236–1245.
Chicago author-date (all authors)
Zarbock, Alexander, Jay L Koyner, Eric Hoste, and John A Kellum. 2018. “Update on Perioperative Acute Kidney Injury.” Anesthesia and Analgesia 127 (5): 1236–1245.
Vancouver
1.
Zarbock A, Koyner JL, Hoste E, Kellum JA. Update on perioperative acute kidney injury. ANESTHESIA AND ANALGESIA. 2018;127(5):1236–45.
IEEE
[1]
A. Zarbock, J. L. Koyner, E. Hoste, and J. A. Kellum, “Update on perioperative acute kidney injury,” ANESTHESIA AND ANALGESIA, vol. 127, no. 5, pp. 1236–1245, 2018.
@article{8571920,
  abstract     = {Acute kidney injury (AKI) in the perioperative period is a common complication and is associated with increased morbidity and mortality. A standard definition and staging system for AKI has been developed, incorporating a reduction of the urine output and/or an increase of serum creatinine. Novel biomarkers may detect kidney damage in the absence of a change in function and can also predict the development of AKI. Several specific considerations for AKI risk are important in surgical patients. The surgery, especially major and emergency procedures in critically ill patients, may cause AKI. In addition, certain comorbidities, such as chronic kidney disease and chronic heart failure, are important risk factors for AKI. Diuretics, contrast agents, and nephrotoxic drugs are commonly used in the perioperative period and may result in a significant amount of in-hospital AKI. Before and during surgery, anesthetists are supposed to optimize the patient, including preventing and treating a hypovolemia and correcting an anemia. Intraoperative episodes of hypotension have to be avoided because even short periods of hypotension are associated with an increased risk of AKI. During the intraoperative period, urine output might be reduced in the absence of kidney injury or the presence of kidney injury with or without fluid responsiveness. Therefore, fluids should be used carefully to avoid hypovolemia and hypervolemia. The Kidney Disease: Improving Global Outcomes guidelines suggest implementing preventive strategies in high-risk patients, which include optimization of hemodynamics, restoration of the circulating volume, institution of functional hemodynamic monitoring, and avoidance of nephrotoxic agents and hyperglycemia. Two recently published studies found that implementing this bundle in high-risk patients reduced the occurrence of AKI in the perioperative period. In addition, the application of remote ischemic preconditioning has been studied to potentially reduce the incidence of perioperative AKI. This review discusses the epidemiology and pathophysiology of surgery-associated AKI, highlights the importance of intraoperative oliguria, and emphasizes potential preventive strategies.},
  author       = {Zarbock, Alexander and Koyner, Jay L and Hoste, Eric and Kellum, John A},
  issn         = {0003-2999},
  journal      = {ANESTHESIA AND ANALGESIA},
  keywords     = {ACUTE-RENAL-FAILURE,RANDOMIZED CLINICAL-TRIAL,MAJOR ABDOMINAL-SURGERY,CRITICALLY-ILL PATIENTS,FUROSEMIDE STRESS TEST,HIGH-RISK PATIENTS,CARDIAC-SURGERY,NONCARDIAC SURGERY,FLUID MANAGEMENT,INTENSIVE-CARE},
  language     = {eng},
  number       = {5},
  pages        = {1236--1245},
  title        = {Update on perioperative acute kidney injury},
  url          = {http://dx.doi.org/10.1213/ane.0000000000003741},
  volume       = {127},
  year         = {2018},
}

Altmetric
View in Altmetric
Web of Science
Times cited: