Table 2.
Perioperative Risk Factors for Postoperative AKI
| Preoperative Factors | Intraoperative Factors | Postoperative Factors |
|---|---|---|
| Preoperative hospital stay >5 d | Emergent surgery (versus elective) | Sepsis |
| Preoperative sepsis | Laparotomy (versus laparoscopy) | Hemodynamic instability |
| Race (African American) | Abdominal surgery | Low cardiac output |
| Sex (male) | IAH | Hypotension |
| Age | Longer duration of surgery | Hypovolemia |
| High ASA physical status | IV contrast Hemodynamic instability |
|
| High RCRI score | Use of diuretics Transfusion of PRBC Highly invasive procedures |
|
| Comorbidities | Cardiac surgery | Respiratory failure Mechanical ventilation |
| CKD | Prolonged aortic cross-clamping | |
| Diabetes mellitus | Need to return to CPB | |
| Chronic pulmonary disease | CPB nonpulsatile | |
| Current smoking | Low-flow and low-pressure perfusion | |
| Congestive heart failure | Low cardiac output | |
| Arterial hypertension | Prolonged hypotension | |
| Peripheral vascular disease | Hypovolemia | |
| Coronary artery disease | Venous congestion | |
| Previous myocardial infarction | Vasopressors and inotropes | |
| Arterial fibrillation | Low hematocrit during CPB | |
| Previous stroke | Embolism | |
| Liver disease | Hemolysis and hemoglobinuria | |
| Cancer | Length of CPB >100–120 min | |
| Bleeding disorders | No use off-pump techniques Concomitant endocarditis IAH |
|
| Medications | Vascular surgery | Leak of surgical anastomosis |
| Diuretics | No use of cold renal perfusion | |
| NSAIDs | Open surgery (versus endovascular) | |
| Nephrotoxic antibiotics | Operative time | |
| Steroids (chronic therapy) | Anatomic complexity | |
| Contrast agents | Bleeding >1000 mL | |
| ACEi/ARBs | Hemoglobin <10 g/dL Time of HCA |
|
| Thrombocytopenia | Transplant surgery | Positive fluid balance within 48 h |
| eGFR reduction | Cirrhosis | Transfusion of PRBC |
| Anemia | CKD | Use of diuretics |
| Hypoalbuminemia | Use of vasopressor | |
| High C-reactive protein | Immunosuppressive drugs | Use of NSAIDs |
| Bicarbonate <23 mEq/L | Resume ACEi 15 d postsurgery |
Abbreviations: ACEi, angiotensin-converting enzyme inhibitors; AKI, acute kidney injury; ARBs, angiotensin receptor blockers; ASA, American Society of Anesthesiologists; CKD, chronic kidney disease; CPB, cardiopulmonary bypass; eGFR, estimated glomerular filtration rate; HCA, hypothermic circulatory arrest; IAH, intra-abdominal hypertension; IV, intravenous; NSAIDs, nonsteroidal anti-inflammatory drugs; PRBC, packed red blood cells; RCRI, Revised Cardiac Risk Index.