Table 1. Perioperative renal protection drugs, techniques, and strategies to be avoided in cardiovascular surgery.

Primum non nocere*	Standard patients	Patients at high risk of AKI
Nephrotoxic drugs (aminoglycosides, NSAIDs, ACEIs, and cyclosporine)	Avoid routine use of nephrotoxic drugs in your department: - Use different antibiotics in your protocols - Use other painkillers - Stop ACEIs at hospital admission or use short-lived ones - Consult specialist for other, less nephrotoxic, drugs	Avoid nephrotoxic drugs in these patients If you consider them lifesaving in a specific patient, use strict monitoring of blood concentration (when possible) and renal function Consider postponing surgery
Contrast medium	Avoid routine use of high-volume dose and hyperosmolar iodinated contrast medium Avoid routine use of contrast medium the day of surgery	Avoid any unnecessary imaging Avoid high-volume dose and hyperosmolar iodinated contrast medium Avoid administration less than 24 hours before surgery Consider postponing surgery by several days even if there was no serum creatinine increase after the contrast medium procedure
Anemia	Avoid routine Ht of less than 21%	Avoid Ht of less than 24%
Hypotension	Avoid long periods of hypotension as routine in your center (start of CPB, control of bleeding) At the same time, avoid routine use of inotropes and vasoconstrictors	Avoid MAP of less than 65 mmHg during CPB Use fluids, transfusions, inotropes, and vasoconstrictors to reach your targets
Fluid management	Avoid fluid overload and routine use of HES	Avoid fluid overload and HES Avoid hypovolemia
Diuretics	Avoid routinely using diuretics to prevent and treat AKI	Avoid using diuretics to prevent and treat AKI In the management of volume overload, consider using continuous infusion instead of boluses
Dopamine	Avoid routine use of low-dose dopamine to prevent AKI	Avoid using low-dose dopamine to prevent or treat AKI
Aspirin	Avoid routine use of aspirin to prevent AKI in the perioperative period	Avoid using NSAIDs

*First do not harm. ACEI, angiotensin-converting enzyme inhibitor; AKI, acute kidney injury; CPB, cardiopulmonary bypass; HES, hydroxyethyl starch; Ht, hematocrit; MAP, mean arterial pressure; NSAID, non-steroidal anti-inflammatory drug.