Accepting a chronic kidney disease patient for perioperative management: a narrative review of key aspects

Chronic kidney disease is one of the leading co-morbidity at present. With the increasing prevalence of diabetes mellitus and hypertension, more and more peoples are developing diabetic and hypertensive nephropathy. As chronic kidney disease patient can present as an asymptomatic stable patient in one end and a multi-organ involved complicated end-stage disease in other ends, their management plan also varies. The serum creatinine levels of as low as 1.5 mg% have been linked to perioperative major cardiac events like myocardial infarction and arrest; these patients poses a challenge to the perioperative team. Moreover, a chance of developing acute kidney injury on the chronic kidney disease is also higher. These patients are also often elderly, with diabetes mellitus and/or hypertension. Therefore, accepting such patient for perioperative care needs systematic and meticulous approach. Preoperative assessment, risk stratification, and optimization play a great role. Both intraoperative and postoperative management needs a tailored approach. The present narrative review is prepared to give the current insight on these aspects. Abbreviations used: AKI – Acute kidney injury; CKD - Chronic kidney disease; ESRD - End stage renal disease; eGFR: estimated Glomerular Filtration Rate; HD – Hemodilaysis; GFR - Glomerular filtration rate; KDIGO - The Kidney Disease: Improving Global Outcomes, RCRI - Revised Cardiac Risk Index; RRT- Renal Replacement Therapy Received: 28 Oct 2018Reviewed: 30 Oct 2018Corrected: 7 Nov 2018Accepted: 7 Nov 2018 Citation: Karim HMR, Panda CK, Singha SK. Accepting a chronic kidney disease patient for perioperative management: a narrative review of key aspects. Anaesth Pain & Intensive Care 2018;22 Suppl 1:S29-S38

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The risk of acute kidney injury following laparoscopic surgery in a chronic kidney disease patient

Clinical Kidney Journal ◽

10.1093/ndtplus/sfr071 ◽

2011 ◽

Vol 4 (5) ◽

pp. 339-341 ◽

Cited By ~ 1

Author(s):

S. de Seigneux ◽

C.-E. Klopfenstein ◽

C. Iselin ◽

P.-Y. Martin

Keyword(s):

Chronic Kidney Disease ◽

Acute Kidney Injury ◽

Laparoscopic Surgery ◽

Kidney Disease ◽

Chronic Kidney Disease Patient ◽

Disease Patient ◽

Kidney Injury

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Found in Translation: Reasons for Optimism in the Pursuit to Prevent Chronic Kidney Disease After Acute Kidney Injury

Canadian Journal of Kidney Health and Disease ◽

10.1177/2054358119868740 ◽

2019 ◽

Vol 6 ◽

pp. 205435811986874

Author(s):

Samuel A. Silver ◽

Casimiro Gerarduzzi

Keyword(s):

Chronic Kidney Disease ◽

Acute Kidney Injury ◽

Kidney Disease ◽

Animal Models ◽

Kidney Injury ◽

Narrative Review ◽

Sources Of Information ◽

Stage Renal Disease ◽

End Stage ◽

Injury Progression

Purpose of review: The current review will discuss on the progress of studying the transition phase between acute kidney injury (AKI) and chronic kidney disease (CKD) through improved animal models, common AKI and CKD pathways, and how human studies may inform different translational approaches. Sources of information: PubMed and Google Scholar. Methods: A narrative review was performed using the main terms “acute kidney injury,” “chronic kidney disease,” “end-stage renal disease,” “animal models,” “review,” “decision-making,” and “translational research.” Key findings: The last decade has shown much progress in the study of AKI, including evidence of a pathophysiological link between AKI and CKD. We are now in a phase of redesigning animal models and discovering mechanisms that can replicate the pathological conditions of the AKI-to-CKD continuum. Translating these findings into the clinic is a barrier that must be overcome. To this end, current efforts include prediction of AKI onset and maladaptive repair, detecting patients susceptible to the progression of chronic maladaptive repair, and understanding shared signaling mechanisms between AKI and CKD. Limitations: This is a narrative review of the literature that is partially influenced by the knowledge, perspectives, and experiences of the authors and their research background. Implications: Overall, this new knowledge from the AKI-to-CKD continuum will help bridge the discontinuity that exists between animal models and patients, resulting in more effective translational biomarkers and therapeutics to test in known AKI pathologies thereby preventing the chronicity of kidney injury progression.

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