Cardiac surgery-associated acute kidney injury

Acute kidney injury (AKI) occurs, according to current definitions, in up to 30% of all patients undergoing cardiac surgery. AKI that requires renal replacement therapy has an incidence of approximately 1%. The development of AKI increases mortality to 15-30%, independently of other comorbidities. Full recovery of renal function is only observed in 50% of surviving patients. Thus, due to its significance, the term cardiac surgery-associated acute kidney injury (CSA AKI) was coined. The underlying mechanisms leading to CSA AKI are not limited to the use of cardiopulmonary bypass. In fact, predominant causes include endogenous and exogenous nephrotoxins, inflammation, hypoperfusion, and metabolic and neurohormonal disturbances. Since no causal therapy is available for CSA AKI, primary and secondary prevention is critical to correct all avoidable and modifiable risk factors of AKI. Renal replacement therapy is only supportive to bridge the gap until the kidneys recover.