Update on Perioperative Acute Kidney Injury

Alexander Zarbock, MD; Jay L. Koyner, MD; Eric A. J. Hoste, MD; John A. Kellum, MD


Anesth Analg. 2018;127(5):1236-1245. 

In This Article


The KDIGO guidelines propose to implement a bundle of preventive measures in patients at high risk for AKI. This bundle consists of maintenance of volume status and perfusion pressure, monitoring of SCr and urine output, discontinuation and avoidance of nephrotoxic agents, use of alternatives to radio contrast agents, maintenance of normoglycemia, and functional hemodynamic monitoring.[2] Recently, a single-center, randomized controlled clinical trial (PrevAKI) showed that biomarker-guided implementation of the KDIGO guidelines compared with standard care significantly decreased the occurrence of AKI in patients undergoing cardiac surgery (absolute risk reduction, 16.6%; 95 CI, 5.5–27.9; P = .004; Table 2).[100] In addition, another single-center trial investigating high-risk patients undergoing major abdominal surgery also demonstrated that optimizing the patients by using a prespecified bundle reduces the occurrence of moderate and severe AKI and shortens length of ICU and hospital stay.[101]