[TJS4-5] Prevention of perioperative AKI
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ライブ配信】
Acute kidney injury (AKI) is one of the most frequent complication in post-surgery patients and strongly associated with the poor outcomes such as death and longer stay in ICU. Unfortunately, no currently available drug that can treat AKI sufficiently exist in the clinical, prevention of AKI is important for postsurgical care. Recently, several strategies have been developed for AKI prevention. First, electric alert (E-alert) using electronic health records has been introduced to change care provider behavior in order to improve quality of AKI care. Previous studies regarding the impact of AKI E-alerts were conflicting; some reported improvement in care processes and patient outcomes, while others showed no effect on clinical outcomes. Another strategy is bundle-based approach with risk stratification by using AKI biomarker. New biomarker will allow to detect AKI earlier than serum creatinine. The Kidney Disease: Improving Global Outcomes (KDIGO) guidelines suggest implementing preventive strategies in high-risk patients, which include optimization of hemodynamics, restoration of the circulating volume, institution of functional hemodynamic monitoring, and avoidance of nephrotoxic agents and hyperglycemia. Two recent interventional studies demonstrated implementing this bundle in high-risk patients reduced the occurrence of AKI in the perioperative period. Lastly, some new drugs that can prevent AKI via different mechanisms of action are currently under evaluation. In conclusion, prevention of perioperative AKI has a great impact on the outcomes and needs to be improved by multidisciplinary approach.