Complicaciones renales en cuidado crítico cardiovascular : Papel de la insuficiencia renal aguda asociada a cirugía cardíaca

Abstract

Acute kidney injury is considered one of the main risk factors associated with mortality in patients undergoing coronary bypass. This factor is preponderant regardless of whether or not the patient requires renal replacement therapy, although with the latter the risk of death is greater. The risk factors most frequently associated with acute kidney injury are: COPD, advanced age, diabetes mellitus, female gender, peripheral vascular disease, pre-existing CKD, CHF, LVEF <35 %, AH, emergency surgery, cardiogenic shock, trunk disease, previous cardiac surgery, prolonged pump time, hemolysis, hemodilution, sepsis and use of nephrotoxic drugs. There are specific recommendations to prevent the presence of kidney injury according to the surgical time: pre, trans or postoperative. Among them, the following must be considered: suspend the blockers of the renin-angiotensin-aldosterone system, define the need for a balloon pump prior to surgery, anesthesia with volatile anesthetics on the use of IV anesthetics, avoid glycemic variability, balanced solutions vs SSN, adequate IV hydration, surgery with ECB over OPCAB, minimizing aortic manipulation, among others. Acute kidney injury in patients with cardiac surgery is a complex syndrome that must be approached from different points of view, where prevention is the mainstay. The significant associated morbidity and mortality leads to multidisciplinary management, considering the identification of patients at risk, proper fluid management, avoiding nephrotoxic drugs and hemodynamic instability, optimizing glycemic control, and avoiding poly-transfusion.