Renal haemodynamics and oxygenation during and after cardiac surgery and cardiopulmonary bypass

R. G. Evans, Y. R. Lankadeva, A. D. Cochrane, B. Marino, N. Iguchi, M. Z. L. Zhu, S. G. Hood, J. A. Smith, R. Bellomo, B. S. Gardiner, C.-J. Lee, D. W. Smith, C. N. May

Research output: Contribution to journalReview ArticleResearchpeer-review

18 Citations (Scopus)

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.

Original languageEnglish
Article numbere12995
Number of pages15
JournalActa Physiologica
Volume222
Issue number3
DOIs
Publication statusPublished - 1 Mar 2018

Keywords

  • acute kidney injury
  • renal hypoxia
  • renal ischaemia
  • renal medulla

Cite this

Evans, R. G., Lankadeva, Y. R., Cochrane, A. D., Marino, B., Iguchi, N., Zhu, M. Z. L., ... May, C. N. (2018). Renal haemodynamics and oxygenation during and after cardiac surgery and cardiopulmonary bypass. Acta Physiologica, 222(3), [e12995]. https://doi.org/10.1111/apha.12995
Evans, R. G. ; Lankadeva, Y. R. ; Cochrane, A. D. ; Marino, B. ; Iguchi, N. ; Zhu, M. Z. L. ; Hood, S. G. ; Smith, J. A. ; Bellomo, R. ; Gardiner, B. S. ; Lee, C.-J. ; Smith, D. W. ; May, C. N. / Renal haemodynamics and oxygenation during and after cardiac surgery and cardiopulmonary bypass. In: Acta Physiologica. 2018 ; Vol. 222, No. 3.
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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.",
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Evans, RG, Lankadeva, YR, Cochrane, AD, Marino, B, Iguchi, N, Zhu, MZL, Hood, SG, Smith, JA, Bellomo, R, Gardiner, BS, Lee, C-J, Smith, DW & May, CN 2018, 'Renal haemodynamics and oxygenation during and after cardiac surgery and cardiopulmonary bypass', Acta Physiologica, vol. 222, no. 3, e12995. https://doi.org/10.1111/apha.12995

Renal haemodynamics and oxygenation during and after cardiac surgery and cardiopulmonary bypass. / Evans, R. G.; Lankadeva, Y. R.; Cochrane, A. D.; Marino, B.; Iguchi, N.; Zhu, M. Z. L.; Hood, S. G.; Smith, J. A.; Bellomo, R.; Gardiner, B. S.; Lee, C.-J.; Smith, D. W.; May, C. N.

In: Acta Physiologica, Vol. 222, No. 3, e12995, 01.03.2018.

Research output: Contribution to journalReview ArticleResearchpeer-review

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T1 - Renal haemodynamics and oxygenation during and after cardiac surgery and cardiopulmonary bypass

AU - Evans, R. G.

AU - Lankadeva, Y. R.

AU - Cochrane, A. D.

AU - Marino, B.

AU - Iguchi, N.

AU - Zhu, M. Z. L.

AU - Hood, S. G.

AU - Smith, J. A.

AU - Bellomo, R.

AU - Gardiner, B. S.

AU - Lee, C.-J.

AU - Smith, D. W.

AU - May, C. N.

PY - 2018/3/1

Y1 - 2018/3/1

N2 - 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.

AB - 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.

KW - acute kidney injury

KW - renal hypoxia

KW - renal ischaemia

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