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Title: Renal haemodynamics and oxygenation during and after cardiac surgery and cardiopulmonary bypass.
Austin Authors: Evans, R G;Lankadeva, Y R;Cochrane, A D;Marino, Bruno;Iguchi, N;Zhu, M Z L;Hood, S G;Smith, J A;Bellomo, Rinaldo ;Gardiner, B S;Lee, C-J;Smith, D W;May, C N
Affiliation: The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Victoria, Australia
Department of Perfusion Services, Austin Health, Heidelberg, Victoria, Australia
Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia
Department of Cardiothoracic Surgery, Monash Health, Monash University, Melbourne, Victoria, Australia
Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
School of Engineering and Information Technology, Murdoch University, Perth, WA, Australia
Faculty of Engineering and Mathematical Sciences, The University of Western Australia, Perth, WA, Australia
Issue Date: Mar-2018 2017-11-30
Publication information: Acta Physiologica 2018; 222(3): e12995
Abstract: Acute kidney injury (AKI) is a common complication following cardiac surgery performed on cardiopulmonary bypass (CPB) and has important implications for prognosis. The aetiology of cardiac surgery-associated AKI is complex, but renal hypoxia, particularly in the medulla, is thought to play at least some role. There is strong evidence from studies in experimental animals, clinical observations and computational models that medullary ischaemia and hypoxia occur during CPB. There are no validated methods to monitor or improve renal oxygenation during CPB, and thus possibly decrease the risk of AKI. Attempts to reduce the incidence of AKI by early transfusion to ameliorate intra-operative anaemia, refinement of protocols for cooling and rewarming on bypass, optimization of pump flow and arterial pressure, or the use of pulsatile flow, have not been successful to date. This may in part reflect the complexity of renal oxygenation, which may limit the effectiveness of individual interventions. We propose a multi-disciplinary pathway for translation comprising three components. Firstly, large-animal models of CPB to continuously monitor both whole kidney and regional kidney perfusion and oxygenation. Secondly, computational models to obtain information that can be used to interpret the data and develop rational interventions. Thirdly, clinically feasible non-invasive methods to continuously monitor renal oxygenation in the operating theatre and to identify patients at risk of AKI. In this review, we outline the recent progress on each of these fronts.
DOI: 10.1111/apha.12995
ORCID: 0000-0002-1650-8939
Journal: Acta Physiologica
PubMed URL: 29127739
Type: Journal Article
Subjects: acute kidney injury
renal hypoxia
renal ischaemia
renal medulla
Appears in Collections:Journal articles

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