Strategy	Rationale	Evidence
Cardiopulmonary Bypass Strategies
Leukocyte filtration	Reduce inflammatory response & associated AKI	Several small, non-randomized studies (n < 100) with some reduction in biomarkers & RRT
Arterial cannula with filter	Reduce micro-emboli to kidneys	1 RCT (n = 1,289) showing reduced incidence of AKI in high-risk patients
Arterial perfusion pressure	Maintaining higher renal perfusion pressure	Several studies (randomized & non-randomized) showing no effect
Surface heparin coating	Varying levels of anticoagulation & associated inflammatory response	Several studies (non-randomized) showing no effect
Hemo-/ultrafiltration	Reduce inflammatory mediators & increase hematocrit	1 RCR (n = 199) suggesting lower biomarkers immediately postoperatively (not later) in patients with reduced eGFR
Fluid Management & Transfusion
Autologous CPB priming	Reduce hemodilution	1 RCT (n = 72) showing no benefit
Volume expanders (HES)	Maintaining intravascular volume/oncotic pressure	4 small RCTs not showing any difference for AKI
Blood salvage/autotransfusion	Reduce hemodilution	2 small RCTs (n = 34, n = 80) not showing a difference for AKI
Maintaining a hematocrit target	Reduce hemodilution	1 RCT (n = 54) showing no benefit to prevent AKI
Preoperative hydration	Maintaining intravascular volume	1 RCT (n = 45) randomizing patients with moderate—severe CKG suggesting lower incidence of AKI/dialysis
Transfusion for low hematocrit	Reduce hemodilution	4 RCT (including TITre2 & TRACS) showing no difference for AKI
Remote ischemic preconditioning	Unclear	10 RCT, 2 showing benefit, 8 showing no benefit; meta-analysis with pooled effect suggesting no benefit (RR .95; .86–1.06) for AKI
Prophylactic dialysis	Unclear	1 RCT (n = 44) with questionable study design suggesting benefit (reduced dialysis)
Pharmacological Strategies.
Diuretics	Increased diuresis	3 small RCT (n = 24, n = 126, n = 50) not showing any benefit in terms of AKI
Vasodilators	Increased renal perfusion	Several small RCTs all showing increased urine output, decreased biomarkers (creatinine) but no reduction in RRT