Journal article
Renal haemodynamics and oxygenation during and after cardiac surgery and cardiopulmonary bypass
Acta Physiologica, Vol.222(3), e12995
2018
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.
Details
- Title
- Renal haemodynamics and oxygenation during and after cardiac surgery and cardiopulmonary bypass
- Authors/Creators
- R.G. Evans (Author/Creator) - Monash UniversityY.R. Lankadeva (Author/Creator) - Florey Institute of Neuroscience and Mental HealthA.D. Cochrane (Author/Creator) - Monash UniversityB. Marino (Author/Creator) - Austin HospitalN. Iguchi (Author/Creator) - Florey Institute of Neuroscience and Mental HealthM.Z.L. Zhu (Author/Creator) - Monash UniversityS.G. Hood (Author/Creator) - Florey Institute of Neuroscience and Mental HealthJ.A. Smith (Author/Creator) - Monash UniversityR. Bellomo (Author/Creator) - Austin HospitalB.S. Gardiner (Author/Creator) - The University of Western AustraliaC-J Lee (Author/Creator) - The University of Western AustraliaD.W. Smith (Author/Creator) - The University of Western AustraliaC.N. May (Author/Creator) - Florey Institute of Neuroscience and Mental Health
- Publication Details
- Acta Physiologica, Vol.222(3), e12995
- Publisher
- John Wiley & Sons Ltd
- Identifiers
- 991005540086207891
- Copyright
- © 2017 Scandinavian Physiological Society
- Murdoch Affiliation
- School of Engineering and Information Technology
- Language
- English
- Resource Type
- Journal article
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- Collaboration types
- Domestic collaboration
- Citation topics
- 1 Clinical & Life Sciences
- 1.55 Urology & Nephrology - General
- 1.55.830 Acute Kidney Injury
- Web Of Science research areas
- Physiology
- ESI research areas
- Biology & Biochemistry