Perioperative acute kidney injury: Stratification and risk reduction strategies

Alexander Gomelsky; Kenneth Abreo; Nazih Khater; Adrian Abreo; Bakhtiar Amin; Madelyn K Craig; Amit Prabhakar; Elyse M Cornett; Richard D Urman; Alan D Kaye

doi:10.1016/j.bpa.2020.04.003

Perioperative acute kidney injury: Stratification and risk reduction strategies

Best Pract Res Clin Anaesthesiol. 2020 Jun;34(2):167-182. doi: 10.1016/j.bpa.2020.04.003. Epub 2020 Apr 22.

Authors

Affiliations

¹ Department of Urology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA. Electronic address: agomel@lsuhsc.edu.
² Department of Urology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA; Department of Nephrology and Hypertension, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA. Electronic address: kabreo@lsuhsc.edu.
³ Department of Urology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA. Electronic address: nkhate@lsuhsc.edu.
⁴ Division of Nephrology, Clerkship Director, Internal Medicine Clerkship, Associate Program Director, Adrian AbreoA, 71103, USA. Electronic address: aabreo@lsuhsc.edu.
⁵ Department of Nephrology and Hypertension, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA. Electronic address: bmoham@lsuhsc.edu.
⁶ Department of Anesthesiology, LSU Health Science Center New Orleans, 1542 Tulane Avenue, New Orleans, LA, 70112, USA. Electronic address: mcrai5@lsuhsc.edu.
⁷ Department of Anesthesiology, Division of Critical Care, Emory University School of Medicine, Atlanta, GA, USA. Electronic address: amit.prabhakar@emory.edu.
⁸ Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA. Electronic address: ecorne@lsuhsc.edu.
⁹ Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA. Electronic address: rurman@bwh.harvard.edu.
¹⁰ Departments of Anesthesiology and Pharmacology, Toxicology, and Neurosciences; Provost, Chief Academic Officer, and Vice Chancellor of Academic Affairs, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA. Electronic address: akaye@lsuhsc.edu.

PMID: 32711827
DOI: 10.1016/j.bpa.2020.04.003

Abstract

Perioperative acute kidney injury (AKI) is associated with increased morbidity and mortality. Patient comorbidities, the type of surgery, timing of surgery, and exposure to nephrotoxins are important contributors for developing acute kidney injury. Urgent or emergent surgery, cardiac, and organ transplantation procedures are associated with a higher risk of acute kidney injury. Nephrotoxic drugs, contrast dye, and diuretics can worsen preexisting kidney dysfunction or act as an additive and/or synergistic insult to perioperative injury. A history of preoperative chronic kidney disease is the main risk factor for developing AKI, conferring as much as a 10-fold risk. However, beyond the preoperative renal function, the development of AKI is a complex phenomenon that involves a combination of patient-related and surgery-related factors.

Keywords: dialysis; nephrotoxins; perioperative period; renal dysfunction.

Published by Elsevier Ltd.

Publication types

Review

MeSH terms

Acute Kidney Injury / etiology*
Acute Kidney Injury / physiopathology
Acute Kidney Injury / prevention & control*
Age Factors
Humans
Postoperative Complications / etiology*
Postoperative Complications / physiopathology
Postoperative Complications / prevention & control*
Renal Insufficiency, Chronic / complications
Renal Insufficiency, Chronic / physiopathology
Risk Assessment / methods
Risk Reduction Behavior*