IMR Press / RCM / Volume 21 / Issue 4 / DOI: 10.31083/j.rcm.2020.04.206
Open Access Systematic Review
Determinants of acute kidney injury after cardiac surgery: a systematic review
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1 Department of Cardiovascular Surgery, Cardiovascular Diseases Institute, 700503, Iasi, Romania
2 ‘Grigore T. Popa’, University of Medicine, 700115, Iasi, Romania
3 Nephrology Clinic, Dialysis, and Renal Transplant Center, ‘C.I. Parhon’ Hospital, 700507, Iasi, Romania
4 Department of Interventional Cardiology, Cardiovascular Diseases Institute, 700503, Iasi, Romania

These authors contributed equally.

Rev. Cardiovasc. Med. 2020 , 21(4), 601–610; https://doi.org/10.31083/j.rcm.2020.04.206
Submitted: 10 October 2020 | Revised: 26 October 2020 | Accepted: 3 November 2020 | Published: 30 December 2020
Abstract

Acute kidney injury following cardiac surgery (CS-AKI) represents a severe postoperative complication, negatively impacting short-term and long-term mortality. Due to the lack of a specific treatment, effective prevention remains the most powerful tool to overcome the CS-AKI burden. Improving the preventive strategies is possible by establishing appropriate preoperative risk profiles. Various clinical models were proposed as a means to assist physicians in stratifying the risk of CS-AKI. However, these models are used for predicting severe forms of CS-AKI, while their predictive power for mild forms is insufficient. Our paper represents the first systematic approach to review all proposed preoperative risk factors and their predictive power. Our strategy is the starting point for selecting and comparing the predictive elements to be integrated into future risk models. Heart failure, chronic hyperglycemia, anemia, obesity, preoperative exposure to nephrotoxic drugs or contrast media, inflammation, proteinuria, and pre-existing kidney disease were systematically reviewed and were found to be associated with an increased risk of postoperative CS-AKI. As no externally validated and universally accepted risk models currently exist, the clinical judgment and a good knowledge of the preoperative risk factors in the light of new evidence may help personalize preoperative risk profiles as the cornerstone of prevention measures.

Keywords
Acute kidney injury
cardiac surgery
risk factors
risk prediction
risk stratification models
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