Perioperative Renoprotection: Clinical Implications

Khaschayar Saadat-Gilani, MD; Alexander Zarbock, MD; Melanie Meersch, MD


Anesth Analg. 2020;131(6):1667-1678. 

In This Article

Incidence and Epidemiology

Approximately 2% to 18% of all hospitalized patients develop AKI during their hospital stay.[14,15] The incidence of AKI in critically ill patients is reported as high as 57%.[16] Patients who develop AKI have an increased mortality, whereas the mortality rates depends on the severity of AKI and can reach up to 60% in patients with dialysis-dependent AKI. Furthermore, health care costs and resource utilization are higher in AKI patients.[17–19]

The most common cause of AKI is sepsis, whereas the second most common cause is surgery. Patients undergoing cardiac surgery have reported AKI incidences of up to 42% based on the complexity of the surgery and the use of the cardiopulmonary bypass, including the activation of the immune and complement system, and redistribution of blood flow.[20–22] A systematic review of major abdominal surgery showed that the incidence of AKI was 13% in this patient population.[23] Additionally, patient-related risk factors for development of AKI like chronic vascular disease, chronic kidney disease, arterial hypertension, cardiac failure, and diabetes are well established and contribute to the overall risk profile.[24]