Table 3.

Summary of all measures that might protect the kidney in cardiac surgery

Preoperative strategies	Intraoperative strategies	Postoperative strategies
-General measures: avoid intravascular volume depletion, optimize cardiac output, avoid nephrotoxic drugs -Aspirin33,34 -Statins continuation39 -Iron if Hb <12.5 and ferritin is <100 mg/L -Using exogenous albumin to correct hypoalbuminemia (level of <4 g/dL) in off-pump CABG surgery35,36	-Zero-balanced ultrafiltration during CPB for patients with eGFR <6047 -DO2 >300 ml with MAP >70 mmHg during CPB48 -Avoid RBC unless Hb <7 g/dL42 -Volatile anesthesia69 -Avoid glycemia >180 mg/dL and large glucose variability49,50 -Program on blood management (TEG-guided transfusion, cell saver and use of tranexamic acid)44 -rIPC in patients with Cleveland score ≥6, with no use of propofol70,71 -Levosimendan for CABG if LVEF <40%83 -Use of vasopressin/terlipressin85	-Keep Hb >8 mg/dL86 -Use of early RRT88,89 -Avoid ACEi/ARB87 -Avoid nephrotoxic drugs -Use of dexmedetomidine84 -Avoid glycemia >180 mg/dL and large glucose variability49,50 -To optimize hemodynamics individually guided by transpulmonary thermodilution first 2 days87

Abbreviations: ACEi, angiotensin-converting enzyme inhibitor; ARB, angiotensin-receptor blocker; CPB, cardio-pulmonary bypass; DO2, oxygen delivery; eGFR, estimated glomerular filtration rate; Hb, hemoglobin; LVEF, left ventricle ejection fraction; RBC, red blood cells; RRT, renal replacement therapy; TEG, thromboelastography.