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Cardiac Surgery-Associated Acute Kidney Injury: Current Update and Perspectives

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiovascular Medicine".

Deadline for manuscript submissions: 25 April 2024 | Viewed by 29381

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Special Issue Editors

Dr. Eduardo Tamayo

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Guest Editor

1. Anesthesiology and Critical Care, Clinical University Hospital of Valladolid, Valladolid, Spain
2. BioCritic. Group for Biomedical Research in Critical Care Medicine, Valladolid, Spain
Interests: personalised medicine; cardiac surgery associated acute kidney injury; cardiac surgery perioperatory management and anesthesia; sepsis; perioperative cognitive decline; delirium

Dr. Christian Ortega-Loubon

E-Mail Website
Guest Editor

BioCritic. Group for Biomedical Research in Critical Care Medicine, Valladolid, Spain
Interests: cardiac surgery associated acute kidney injury; endocarditis; perioperative care

Dr. Pablo Jorge-Monjas

E-Mail Website
Guest Editor

1. Anesthesiology and Critical Care, Clinical University Hospital of Valladolid, Valladolid, Spain
2. BioCritic. Group for Biomedical Research in Critical Care Medicine, Valladolid, Spain
Interests: acute kidney injury; cardiac surgery associated acute kidney injury; cardiac surgery perioperatory management and anesthesia; sepsis

Special Issue Information

Dear Colleagues,

Cardiac surgery-associated acute kidney injury (CSA-AKI) is a recognized and serious complication and one of the stronger risk factors for mortality in patients undergoing cardiac surgery. In its more severe form, it increases the likelihood of death by 50%-80%. Even a mild increase in serum creatinine after cardiac surgery entails a higher morbidity with longer length of stay in both hospital and intensive care unit and higher costs of care.

Despite all the recent advancements, we need to improve both our general understanding and our capacity to effectively diagnose, treat and/or prevent CSA-AKI, as it still is a widely held concern and remains as a threat to the critical care team. This Special Issue aims not only to provide an updated comprehensive approach of this disease, in which milieu of factors are intertwined, but also to introduce the latest advances in diagnosis, treatment, and prevention strategies to try to properly tackle this issue.

On behalf of the Journal of Clinical Medicine, we are kindly inviting authors to contribute to the Special Issue “Cardiac Surgery-Associated Acute Kidney Injury: Current Update and Perspectives”. Original articles and Reviews are welcome.

Dr. Eduardo Tamayo
Dr. Christian Ortega-Loubon
Dr. Pablo Jorge-Monjas
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

acute kidney injury
cardiac surgery associated acute kidney injury
CSA-AKI risk factors and prediction scores
perioperative Management, Goal directed perioperative care for CSA-AKI prevention
goal directed perfusion strategy
diagnosis
monitoring renal function
biomarkers
prevention
fluids and diuretics for CSA-AKI
renal replacement therapy for CSA-AKI
renal replacement therapy for immunomodulation in high risk cardiac surgery

Published Papers (10 papers)

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Editorial

Jump to: Research, Review

3 pages, 188 KiB

Open AccessEditorial

Cardiac Surgery-Associated Acute Kidney Injury: Current Updates and Perspectives

by Christian Ortega-Loubon, Eduardo Tamayo and Pablo Jorge-Monjas

J. Clin. Med. 2022, 11(11), 3054; https://doi.org/10.3390/jcm11113054 - 28 May 2022

Cited by 2 | Viewed by 1573

Abstract

(This article belongs to the Special Issue Cardiac Surgery-Associated Acute Kidney Injury: Current Update and Perspectives)

Research

Jump to: Editorial, Review

12 pages, 2004 KiB

Open AccessArticle

Influence of Renal Dysfunction on the Differential Behaviour of Procalcitonin for the Diagnosis of Postoperative Infection in Cardiac Surgery

by Olga de la Varga-Martínez, Marta Martín-Fernández, María Heredia-Rodríguez, Francisco Ceballos, Hector Cubero-Gallego, Juan Manuel Priede-Vimbela, Miguel Bardají-Carrillo, Laura Sánchez-de Prada, Rocío López-Herrero, Pablo Jorge-Monjas, Eduardo Tamayo and Esther Gómez-Sánchez

J. Clin. Med. 2022, 11(24), 7274; https://doi.org/10.3390/jcm11247274 - 07 Dec 2022

Cited by 2 | Viewed by 1491

Abstract

Background: procalcitonin is a valuable marker in the diagnosis of bacterial infections; however, the impairment of renal function can influence its diagnostic precision. The objective of this study is to evaluate the differential behaviour of procalcitonin, as well as its usefulness in the diagnosis of postoperative pulmonary infection after cardiac surgery, depending on the presence or absence of impaired renal function. Materials and methods: A total of 805 adult patients undergoing cardiac surgery with extracorporeal circulation (CBP) were prospectively recruited, comparing the behaviour of biomarkers between the groups with and without postoperative pneumonia and according to the presence or absence of renal dysfunction. Results: Pulmonary infection was diagnosed in 42 patients (5.21%). In total, 228 patients (28.32%) presented postoperative renal dysfunction. Procalcitonin was significantly higher in infected patients, even in the presence of renal dysfunction. The optimal procalcitonin threshold differed markedly in patients with renal dysfunction compared to patients without renal dysfunction (1 vs. 0.78 ng/mL p < 0.05). The diagnostic accuracy of procalcitonin increased significantly when the procalcitonin threshold was adapted to renal function. Conclusions: Procalcitonin is an accurate marker of postoperative infection in cardiac surgery, even in the presence of renal dysfunction. Renal function is an important determinant of procalcitonin levels and, therefore, its diagnostic thresholds must be adapted in the presence of renal dysfunction. Full article

(This article belongs to the Special Issue Cardiac Surgery-Associated Acute Kidney Injury: Current Update and Perspectives)

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11 pages, 549 KiB

Open AccessArticle

Impact of Oxygen Delivery on the Development of Acute Kidney Injury in Patients Undergoing Valve Heart Surgery

by Elena Carrasco-Serrano, Pablo Jorge-Monjas, María Fé Muñoz-Moreno, Esther Gómez-Sánchez, Juan Manuel Priede-Vimbela, Miguel Bardají-Carrillo, Héctor Cubero-Gallego, Eduardo Tamayo and Christian Ortega-Loubon

J. Clin. Med. 2022, 11(11), 3046; https://doi.org/10.3390/jcm11113046 - 28 May 2022

Cited by 5 | Viewed by 2143

Abstract

One of the strongest risk factors for death in individuals undergoing cardiac surgery is Cardiac Surgery Associated-Acute Kidney Injury (CSA-AKI). Although the minimum kidney oxygen delivery index (DO₂i) during cardiopulmonary bypass (CPB) has been reported, the optimal threshold value has not yet been established. A prospective study was conducted from June 2012 to January 2016 to asses how DO₂i influences the pathogenesis of CSA-AKI, as well as its most favorable cut-off value. DO₂ levels were recorded at the beginning, middle, and end of the CPB. The association between DO₂i and CSA-AKI was investigated using multivariable logistic regression analysis. The optimal cut-off of DO₂i as a predictor of CSA-AKI was determined using Classification and Regression Tree (CART) analysis. A total of 782 consecutive patients were enrolled. Of these, 231 (29.5%) patients developed AKI. Optimal DO₂i thresholds of 303 mL/min/m² during the CPB and 295 mL/min/m² at the end of the intervention were identified, which increased the odds of CSA-AKI almost two-fold (Odds Ratio (OR), 1.90; 95% CI, 1.12–3.24) during the surgery and maintained that risk (OR 1.94; 95% CI, 1.15–3.29) until the end. Low DO₂i during cardiopulmonary bypass is a risk factor for CSA-AKI that cannot be ruled out. Continuous renal oxygen supply monitoring for adult patients could be a promising method for predicting AKI during CPB. Full article

(This article belongs to the Special Issue Cardiac Surgery-Associated Acute Kidney Injury: Current Update and Perspectives)

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12 pages, 314 KiB

Open AccessArticle

Risk Factors for Acute Kidney Injury Following Cardiac Surgery and Performance of Leicester Score in a Spanish Cohort

by Alícia Molina Andújar, Alvaro Lucas, Victor Joaquin Escudero, Irene Rovira, Purificación Matute, Cristina Ibañez, Miquel Blasco, Elena Sandoval, Jesús Ruiz, Marina Chorda Sánchez, Gaston J. Piñeiro, Eduard Quintana and Esteban Poch

J. Clin. Med. 2022, 11(4), 904; https://doi.org/10.3390/jcm11040904 - 09 Feb 2022

Cited by 4 | Viewed by 1761

Abstract

The incidence of acute kidney injury following cardiac surgery (CSA-AKI) is up to 30%, and it places patients at an increased risk of death. The Leicester score (LS) is a new score that predicts CSA-AKI of any stage with better discrimination compared to previous scores. The aim of this study was to identify risk factors for CSA-AKI and to assess the performance of LS. A unicentric retrospective study of patients that required cardiac surgery with cardio-pulmonary bypass (CPB) in 2015 was performed. The inclusion criteria were patients over 18 years old who were operated on for cardiac surgery (valve substitution (VS), Coronary Artery Bypass Graft (CABG), or a combination of both procedures and requiring CPB). CSA-AKI was defined with the Kidney Disease Improving Global Outcomes (KDIGO) criteria. In the multivariate analysis, hypertension (odds ratio 1.883), estimated glomerular filtration rate (EGFR) <60 mL/min (2.365), and peripheral vascular disease (4.66) were associated with the outcome. Both discrimination and calibration were better when the LS was used compared to the Cleveland Clinic Score and Euroscore II, with an area under the curve (AUC) of 0.721. In conclusion, preoperative hypertension in patients with CKD with or without peripheral vasculopathy can identify patients who are at risk of CSA-AKI. The LS was proven to be a valid score that could be used to identify patients who are at risk and who could benefit from intervention studies. Full article

(This article belongs to the Special Issue Cardiac Surgery-Associated Acute Kidney Injury: Current Update and Perspectives)

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16 pages, 645 KiB

Open AccessArticle

Cardiac Surgery Associated AKI Prevention Strategies and Medical Treatment for CSA-AKI

by Marlies Ostermann, Gudrun Kunst, Eleanor Baker, Kittisak Weerapolchai and Nuttha Lumlertgul

J. Clin. Med. 2021, 10(22), 5285; https://doi.org/10.3390/jcm10225285 - 14 Nov 2021

Cited by 20 | Viewed by 6727

Abstract

Acute kidney injury (AKI) is common after cardiac surgery. To date, there are no specific pharmacological therapies. In this review, we summarise the existing evidence for prevention and management of cardiac surgery-associated AKI and outline areas for future research. Preoperatively, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers should be withheld and nephrotoxins should be avoided to reduce the risk. Intraoperative strategies include goal-directed therapy with individualised blood pressure management and administration of balanced fluids, the use of circuits with biocompatible coatings, application of minimally invasive extracorporeal circulation, and lung protective ventilation. Postoperative management should be in accordance with current KDIGO AKI recommendations. Full article

(This article belongs to the Special Issue Cardiac Surgery-Associated Acute Kidney Injury: Current Update and Perspectives)

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14 pages, 9439 KiB

Open AccessArticle

Severity and Duration of Acute Kidney Injury and Chronic Kidney Disease after Cardiac Surgery

by Suk Hyung Choe, Hyeyeon Cho, Jinyoung Bae, Sang-Hwan Ji, Hyun-Kyu Yoon, Ho-Jin Lee, Ji-Hyun Lee, Jin-Tae Kim and Won Ho Kim

J. Clin. Med. 2021, 10(8), 1556; https://doi.org/10.3390/jcm10081556 - 07 Apr 2021

Cited by 8 | Viewed by 2270

Abstract

We aimed to evaluate whether the duration and stage of acute kidney injury (AKI) are associated with the occurrence of chronic kidney disease (CKD) in patients undergoing cardiac or thoracic aortic surgery. A total of 2009 cases were reviewed. The patients with postoperative AKI stage 1 and higher stage were divided into transient (serum creatinine elevation ≤48 h) or persistent (>48 h) AKI, respectively. Estimated glomerular filtration rate (eGFR) values during three years after surgery were collected. Occurrence of new-onset CKD stage 3 or higher or all-cause mortality was determined as the primary outcome. Multivariable Cox regression and Kaplan–Meier survival analysis were performed. The Median follow-up of renal function after surgery was 32 months. The cumulative incidences of our primary outcome at one, two, and three years after surgery were 19.8, 23.7, and 26.1%. There was a graded significant association of AKI with new-onset CKD during three years after surgery, except for transient stage 1 AKI (persistent stage 1: HR 3.11, 95% CI 2.62–4.91; transient higher stage: HR 4.07, 95% CI 2.98–6.11; persistent higher stage: HR 13.36, 95% CI 8.22–18.72). There was a significant difference in survival between transient and persistent AKI at the same stage. During three years after cardiac surgery, there was a significant and graded association between AKI stages and the development of new-onset CKD, except for transient stage 1 AKI. This association was stronger when AKI lasted more than 48 h at the same stage. Both duration and severity of AKI provide prognostic value to predict the development of CKD. Full article

(This article belongs to the Special Issue Cardiac Surgery-Associated Acute Kidney Injury: Current Update and Perspectives)

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Review

Jump to: Editorial, Research

24 pages, 2289 KiB

Open AccessReview

Diagnosis of Cardiac Surgery-Associated Acute Kidney Injury: State of the Art and Perspectives

by Alfredo G. Casanova, Sandra M. Sancho-Martínez, Laura Vicente-Vicente, Patricia Ruiz Bueno, Pablo Jorge-Monjas, Eduardo Tamayo, Ana I. Morales and Francisco J. López-Hernández

J. Clin. Med. 2022, 11(15), 4576; https://doi.org/10.3390/jcm11154576 - 05 Aug 2022

Cited by 4 | Viewed by 2309

Abstract

Diagnosis of cardiac surgery-associated acute kidney injury (CSA-AKI), a syndrome of sudden renal dysfunction occurring in the immediate post-operative period, is still sub-optimal. Standard CSA-AKI diagnosis is performed according to the international criteria for AKI diagnosis, afflicted with insufficient sensitivity, specificity, and prognostic capacity. In this article, we describe the limitations of current diagnostic procedures and of the so-called injury biomarkers and analyze new strategies under development for a conceptually enhanced diagnosis of CSA-AKI. Specifically, early pathophysiological diagnosis and patient stratification based on the underlying mechanisms of disease are presented as ongoing developments. This new approach should be underpinned by process-specific biomarkers including, but not limited to, glomerular filtration rate (GFR) to other functions of renal excretion causing GFR-independent hydro-electrolytic and acid-based disorders. In addition, biomarker-based strategies for the assessment of AKI evolution and prognosis are also discussed. Finally, special focus is devoted to the novel concept of pre-emptive diagnosis of acquired risk of AKI, a premorbid condition of renal frailty providing interesting prophylactic opportunities to prevent disease through diagnosis-guided personalized patient handling. Indeed, a new strategy of risk assessment complementing the traditional scores based on the computing of risk factors is advanced. The new strategy pinpoints the assessment of the status of the primary mechanisms of renal function regulation on which the impact of risk factors converges, namely renal hemodynamics and tubular competence, to generate a composite and personalized estimation of individual risk. Full article

(This article belongs to the Special Issue Cardiac Surgery-Associated Acute Kidney Injury: Current Update and Perspectives)

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19 pages, 877 KiB

Open AccessReview

CSA-AKI: Incidence, Epidemiology, Clinical Outcomes, and Economic Impact

by Alan Schurle and Jay L. Koyner

J. Clin. Med. 2021, 10(24), 5746; https://doi.org/10.3390/jcm10245746 - 08 Dec 2021

Cited by 18 | Viewed by 4255

Abstract

Cardiac surgery-associated acute kidney injury (CSA-AKI) is a common complication following cardiac surgery and reflects a complex biological combination of patient pathology, perioperative stress, and medical management. Current diagnostic criteria, though increasingly standardized, are predicated on loss of renal function (as measured by functional biomarkers of the kidney). The addition of new diagnostic injury biomarkers to clinical practice has shown promise in identifying patients at risk of renal injury earlier in their course. The accurate and timely identification of a high-risk population may allow for bundled interventions to prevent the development of CSA-AKI, but further validation of these interventions is necessary. Once the diagnosis of CSA-AKI is established, evidence-based treatment is limited to supportive care. The cost of CSA-AKI is difficult to accurately estimate, given the diverse ways in which it impacts patient outcomes, from ICU length of stay to post-hospital rehabilitation to progression to CKD and ESRD. However, with the global rise in cardiac surgery volume, these costs are large and growing. Full article

(This article belongs to the Special Issue Cardiac Surgery-Associated Acute Kidney Injury: Current Update and Perspectives)

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9 pages, 722 KiB

Open AccessReview

Diagnosis of Cardiac Surgery-Associated Acute Kidney Injury

by Christina Massoth and Alexander Zarbock

J. Clin. Med. 2021, 10(16), 3664; https://doi.org/10.3390/jcm10163664 - 19 Aug 2021

Cited by 8 | Viewed by 2642

Abstract

Acute kidney injury after cardiac surgery is characterized by specific patterns of damage and recovery that are important to consider for management and outcome. The Kidney Disease: Improving Global Outcomes (KDIGO) classification covers only part of the conceptual framework and is thus insufficient for a comprehensive diagnosis. This review highlights the strengths and limitations of the recent criteria and provides an overview of biomarkers of cardiac surgery-associated acute kidney injury (CSA-AKI). The evolving understanding of CSA-AKI as a time-sensitive condition has increased the demand to enhance the diagnostic criteria and translate biomarkers into clinical practice. Full article

(This article belongs to the Special Issue Cardiac Surgery-Associated Acute Kidney Injury: Current Update and Perspectives)

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33 pages, 1941 KiB

Open AccessReview

Genetic Susceptibility to Acute Kidney Injury

by Christian Ortega-Loubon, Pedro Martínez-Paz, Emilio García-Morán, Álvaro Tamayo-Velasco, Francisco J. López-Hernández, Pablo Jorge-Monjas and Eduardo Tamayo

J. Clin. Med. 2021, 10(14), 3039; https://doi.org/10.3390/jcm10143039 - 08 Jul 2021

Cited by 11 | Viewed by 3017

Abstract

Acute kidney injury (AKI) is a widely held concern related to a substantial burden of morbidity, mortality and expenditure in the healthcare system. AKI is not a simple illness but a complex conglomeration of syndromes that often occurs as part of other syndromes in its wide clinical spectrum of the disease. Genetic factors have been suggested as potentially responsible for its susceptibility and severity. As there is no current cure nor an effective treatment other than generally accepted supportive measures and renal replacement therapy, updated knowledge of the genetic implications may serve as a strategic tactic to counteract its dire consequences. Further understanding of the genetics that predispose AKI may shed light on novel approaches for the prevention and treatment of this condition. This review attempts to address the role of key genes in the appearance and development of AKI, providing not only a comprehensive update of the intertwined process involved but also identifying specific markers that could serve as precise targets for further AKI therapies. Full article

(This article belongs to the Special Issue Cardiac Surgery-Associated Acute Kidney Injury: Current Update and Perspectives)

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