Evidence-based renal protection in cardiac surgery.

Published

Journal Article (Review)

Acute renal dysfunction is a common serious complication of cardiac surgery. Although a diversity of mechanisms exist by which the kidney can be damaged during cardiac surgery, atheroembolism, ischemia-reperfusion, and inflammation are believed to be primary contributors to perioperative renal insult. In addition, the high metabolic demands of active tubular reabsorption and the oxygen diffusion shunt characteristic of renal circulation make the kidney particularly vulnerable to ischemic injury. Remote effects of acute renal injury likely contribute to the strong association of this condition with other major postoperative morbidities and mortality and justify the search for renoprotective agents, even when dialysis is never required. Nonpharmacologic preventive strategies include procedure planning that is based on risk stratification, avoidance of nephrotoxins, and meticulous perioperative clinical care, including optimizing intravascular volume and attention to modifiable risk factors such as minimizing hemodilution. Although numerous pharmacologic interventions to prevent or treat acute renal injury have shown promise in animal models, randomized placebo-controlled clinical trials that have looked at measures of significant adverse outcomes such as death and dialysis have not confirmed a benefit.

Full Text

Duke Authors

Cited Authors

  • Stafford-Smith, M

Published Date

  • March 2005

Published In

Volume / Issue

  • 9 / 1

Start / End Page

  • 65 - 76

PubMed ID

  • 15735845

Pubmed Central ID

  • 15735845

International Standard Serial Number (ISSN)

  • 1089-2532

Digital Object Identifier (DOI)

  • 10.1177/108925320500900107

Language

  • eng

Conference Location

  • United States