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      Acute Kidney Injury Associated with Cardiac Surgery: a Comprehensive Literature Review

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          Abstract

          Objective

          To comprehensively understand cardiac surgeryassociated acute kidney injury (CSA-AKI) and methods of prevention of such complication in cardiac surgery patients.

          Methods

          A comprehensive literature search was performed using the electronic database to identify articles describing acute kidney injury (AKI) in patients that undergone cardiac surgery. There was neither time limit nor language limit on the search. The results were narratively summarized.

          Results

          All the relevant articles have been extracted; results have been summarized in each related section. CSA-AKI is a serious postoperative complication and it can contribute to a significant increase in perioperative morbidity and mortality rates. Optimization of factors that can reduce CSA-AKI, therefore, contributes to a better postoperative outcome.

          Conclusion

          Several factors can significantly increase the rate of AKI; identification and minimization of such factors can lead to lower rates of CSA-AKI and lower perioperative morbidity and mortality rates.

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          Most cited references72

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          KDIGO Clinical Practice Guidelines for Acute Kidney Injury

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            The definition of acute kidney injury and its use in practice

            Acute kidney injury (AKI) is a common syndrome that is independently associated with increased mortality. A standardized definition is important to facilitate clinical care and research. The definition of AKI has evolved rapidly since 2004, with the introduction of the Risk, Injury, Failure, Loss, and End-stage renal disease (RIFLE), AKI Network (AKIN), and Kidney Disease Improving Global Outcomes (KDIGO) classifications. RIFLE was modified for pediatric use (pRIFLE). They were developed using both evidence and consensus. Small rises in serum creatinine are independently associated with increased mortality, and hence are incorporated into the current definition of AKI. The recent definition from the international KDIGO guideline merged RIFLE and AKIN. Systematic review has found that these definitions do not differ significantly in their performance. Health-care staff caring for children or adults should use standard criteria for AKI, such as the pRIFLE or KDIGO definitions, respectively. These efforts to standardize AKI definition are a substantial advance, although areas of uncertainty remain. The new definitions have enabled the use of electronic alerts to warn clinicians of possible AKI. Novel biomarkers may further refine the definition of AKI, but their use will need to produce tangible improvements in outcomes and cost effectiveness. Further developments in AKI definitions should be informed by research into their practical application across health-care providers. This review will discuss the definition of AKI and its use in practice for clinicians and laboratory scientists.
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              Kidney disease: improving global outcomes (KDIGO) acute kidney injury work group. KDIGO clinical practice guideline for acute kidney injury.

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                Author and article information

                Contributors
                Role: MBChB, MRCS, MSc
                Role: MBChB
                Role: MD
                Role: MRCS, MSc
                Journal
                Braz J Cardiovasc Surg
                Braz J Cardiovasc Surg
                rbccv
                Brazilian Journal of Cardiovascular Surgery
                Sociedade Brasileira de Cirurgia Cardiovascular
                0102-7638
                1678-9741
                Mar-Apr 2020
                Mar-Apr 2020
                : 35
                : 2
                : 211-224
                Affiliations
                [1 ]Department of Cardiothoracic Surgery, Liverpool Heart and Chest, Liverpool, UK.
                [2 ]Department of Cardiology, Countess of Chester Hospital, Chester, UK.
                [3 ]School of Medicine, University of Liverpool, Liverpool, UK.
                Author notes
                Correspondence Address: Amer Harky, https://orcid.org/0000-0001-5507-5841, Department of Vascular Surgery, Countess of Chester Hospital, Countess of Chester Health Park, Liverpool Road, Chester, United Kingdom of Great Britain and Northern Ireland - Zip code: CH2 1UL. E-mail: aaharky@ 123456gmail.com
                Author information
                http://orcid.org/0000-0001-5507-5841
                Article
                10.21470/1678-9741-2019-0122
                7199993
                32369303
                2c06981a-49d5-4e70-95ba-1697febbd34b

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 13 April 2019
                : 10 June 2019
                Categories
                Review Article

                acute kidney injury,cardiac surgical procedures,postoperative period,postoperative complications

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