Table 3.

Perioperative AKI prevention and management.

Perioperative AKI prevention		Perioperative AKI management
Inclusion of renal risk confirmation in preoperative assessment	a) Enhance preoperative specialist evaluation and optimize surgical plan	Early diagnosis	Discovery of AKI etiology Use of biomarkers to supplement serum creatinine and urine output for the early identification of AKI in high-risk patients
	b) Incorporate a multidisciplinary approach to the perioperative care for patients at high risk of AKI
Minimize intraoperative renal toxin exposure	a) Avoid ACEI or ARB drugs in the perioperative period	Discovery of AKI complications	Correction of disorders of acid-base balance, water and electrolyte imbalance, etc.
	b) Use NSAIDS with caution in the perioperative period, avoid in certain special cases, or choose alternative analgesics	Administration of vasopressors	Maintenance of adequate perfusion pressure (mean arterial pressure > 65 mmHg, systolic pressure > 100 mmHg)
	c) Use the lowest volume of contrast agent that achieves the examination while considering first non-ionic isotonic contrast agent or hypotonic contrast agent	Use of other drugs	Dexmedetomidine: currently considered the most promising effect (in order to ensure the safe use of dexmedetomidine, patients must be carefully selected in clinical practice and the appropriate dose must be determined)
	d) The specific benefits of perioperative hydration are controversial, but studies continue to support this prophylactic measure		Furosemide: guidelines recommend only for correction of fluid imbalances and electrolyte abnormalities in patients with AKI Sodium bicarbonate, dopamine, vasodilators, and natriuretic peptides: not recommended by guidelines at this time
	e) The effectiveness of acetylcysteine and pentoxifylline is still controversy
	f) Statins may help to reduce the incidence of CI-AKI, but their mechanism of action has not been fully determined
Intraoperative management and hemodynamic optimization	a) The routine use of hydroxyethyl starch in surgery is not currently recommended for patients with AKI or co-operative risk factors	Nutritional support	Patients with AKI at any stage: ensure an energy intake of 20–30 kcal/kg/day CRRT treatment: provide up to 1.7 g/kg/day of amino acids
	b) Balanced salt solution is recommended to maintain adequate renal perfusion		Non-dialysis patients: provide 0.8–1.0 g/kg/day of amino acids
	c) Guaranteed MAP > 60–65 mmHg (>75 mmHg in chronic hypertensive patients)
Remote ischemic preadaptation	a) Remote ischemic preadaptation reduced the incidence of major adverse renal events in patients undergoing high-risk cardiac surgery	Renal replacement therapy	Correction of internal environmental disturbances and reduction of excessive fluid load
	b) Remote ischemic preadaptation may promote renal recovery in patients with perioperative AKI
Drug prevention	c) Statins have been shown to reduce the incidence of perioperative AKI