New Review: Importance of Haemodynamic Management in Avoiding AKI in Surgery
Acute Kidney Injury(AKI) is a major contributor to adverse surgical outcomes. Multiple publications point to peri‐operative AKI’s association with short‐ and long‐term complications, longer hospital stay, premature chronic kidney disease and increased mortality. A new article places haemodynamic management high on the list of priorities in the avoidance of this debilitating and expensive adverse surgical outcome.
The new review in Anaesthesia investigates the epidemiology of peri‐operative acute kidney injury. It states that while the cause of AKI “varies depending on the definition, type of surgery and acute and chronic comorbidities,” there are a few common pathogenic factors. These include: “Haemodynamic instability, disturbance of the microcirculation, endothelial dysfunction, inflammation and tubular cell injury.”
The authors remind us that there are no specific therapies. This leaves the anaesthetist to adopt a range of avoidance strategies that protect renal function during the peri‐operative period. These are almost exclusively related to keeping the patient in their haemodynamic sweet spot. Optimal haemodynamic control extends to prevention of hypotension and meticulous fluid management. Specifically this means the avoidance of both hypovolaemia and hypervolaemia.
Incidence of AKI is repeatedly documented at around 8% of major surgical procedures. The economic benefit of avoiding this avoidable complication by adopting optimal haemodynamic management strategies is clear. The authors highlight the FEDORA Randomised Control Trial in which clinicians employed an algorithm using the Oesophageal Doppler Monitor (ODM+) to manage the patients’ haemodynamics. The incidence of post-operative AKI was reduced by 92%.
For Deltex Medical, CEO Andy Mears states; “this is a superb review and well worth a detailed read. What’s abundantly clear is that the fluid management regime largely dictates the incidence of AKI. With that being the case it’s hard to avoid the conclusion that one should adopt the only haemodynamic monitoring technology that’s clinically proven, real-time and accurate, which is the ODM+ as found in Deltex’s TrueView system.”