Cardiac Surgery-Associated Acute Kidney Injury: A Continuum From Pathophysiological Mechanisms to Prevention, Management, and Long-Term Care
Keywords:
Cardiac Surgery, Acute Kidney Injury, Cardiopulmonary Bypass, Renal Biomarkers, Perioperative Renal Protection, Renal Replacement Therapy, Long-Term OutcomesAbstract
Cardiac surgery-associated acute kidney injury (CSA-AKI) remains a frequent and clinically important complication after coronary artery bypass grafting, valve surgery, and complex aortic procedures. Its development reflects the interaction of pre-existing renal vulnerability with perioperative insults, including renal hypoperfusion, ischemia-reperfusion injury, systemic inflammation, oxidative stress, hemolysis, cardiopulmonary bypass-related injury, and nephrotoxic exposure. Conventional diagnostic markers, particularly serum creatinine and urine output, often identify AKI only after functional decline has occurred, limiting opportunities for early intervention. Novel biomarkers such as NGAL, KIM-1, cystatin C, and TIMP-2/IGFBP7 may improve early risk stratification, although their routine clinical implementation remains limited by cost, availability, and uncertainty regarding biomarker-guided treatment pathways. Current prevention and management strategies therefore rely primarily on early risk assessment, hemodynamic optimization, avoidance of nephrotoxins, careful fluid management, and timely renal support. Importantly, CSA-AKI is increasingly recognized as a continuum extending beyond hospitalization, with increased risks of chronic kidney disease, cardiovascular events, and long-term mortality. This review synthesizes current evidence on the mechanisms, diagnosis, prevention, management, and follow-up of CSA-AKI, while highlighting areas where stronger clinical evidence is still needed.
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