Cardiac surgery-associated acute kidney injury (CS-AKI) is common and is associated with increased risk for postoperative morbidity and mortality. Our recent survey of the Society of Cardiovascular Anesthesiologists (SCA) membership showed 6 potentially renoprotective strategies for which clinicians would most value an evidence-based review (ie, intraoperative target blood pressure, choice of specific vasopressor agent, erythrocyte transfusion threshold, use of alpha-2 agonists, goal-directed oxygen delivery on cardiopulmonary bypass [CPB], and the “Kidney Disease Improving Global Outcomes [KDIGO] bundle of care”). Thus, the SCA’s Continuing Practice Improvement Acute Kidney Injury Working Group aimed to provide a practice update for each of these strategies in cardiac surgical patients based on the evidence from randomized controlled trials (RCTs). PubMed, EMBASE, and Cochrane library databases were comprehensively searched for eligible studies from inception through February 2021, with search results updated in August 2021. A total of 15 RCTs investigating the effects of the above-mentioned strategies on CS-AKI were included for meta-analysis. For each strategy, the level of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. Across the 6 potentially renoprotective strategies evaluated, current evidence for their use was rated as “moderate,” “low,” or “very low.” Based on eligible RCTs, our analysis suggested using goal-directed oxygen delivery on CPB and the “KDIGO bundle of care” in high-risk patients to prevent CS-AKI (moderate level of GRADE evidence). Our results suggested considering the use of vasopressin in vasoplegic shock patients to reduce CS-AKI (low level of GRADE evidence). The decision to use a restrictive versus liberal strategy for perioperative red cell transfusion should not be based on concerns for renal protection (a moderate level of GRADE evidence). In addition, targeting a higher mean arterial pressure during CPB, perioperative use of dopamine, and use of dexmedetomidine did not reduce CS-AKI (a low or very low level of GRADE evidence). This review will help clinicians provide evidence-based care, targeting improved renal outcomes in adult patients undergoing cardiac surgery.

心脏手术相关的急性肾损伤 (CS-AKI) 很常见，并且与术后发病率和死亡率的风险增加有关。我们最近对心血管麻醉医师协会 (SCA) 会员的调查显示，临床医生最重视循证审查的 6 种潜在肾脏保护策略（即术中目标血压、特定血管加压药物的选择、红细胞输血阈值、α -2 激动剂、体外循环中目标导向的氧气输送 [CPB] 和“肾脏疾病改善全球结果 [KDIGO] 捆绑治疗”）。因此，SCA 的持续实践改进急性肾损伤工作组旨在根据随机对照试验 (RCT) 的证据，为心脏手术患者的这些策略中的每一种提供实践更新。PubMed、EMBASE 和 Cochrane 图书馆数据库从开始到 2021 年 2 月全面检索符合条件的研究，检索结果于 2021 年 8 月更新。共纳入 15 项研究上述策略对 CS-AKI 影响的 RCT -分析。对于每个策略，使用建议分级、评估、开发和评估 (GRADE) 方法评估证据级别。在评估的 6 种潜在的肾脏保护策略中，目前使用它们的证据被评为“中等”、“低”或“非常低”。根据符合条件的 RCT，我们的分析建议在 CPB 中使用目标导向的氧气输送和高危患者的“KDIGO 捆绑治疗”来预防 CS-AKI（中等级别的 GRADE 证据）。我们的研究结果建议考虑在血管麻痹性休克患者中使用加压素以减少 CS-AKI（低水平的 GRADE 证据）。围手术期红细胞输注采用限制性策略还是宽松策略的决定不应基于对肾脏保护的担忧（中等级别的 GRADE 证据）。此外，在 CPB 期间以更高的平均动脉压为目标、围手术期使用多巴胺和使用右美托咪定并没有降低 CS-AKI（低或非常低水平的 GRADE 证据）。这篇综述将帮助临床医生提供循证护理，以改善接受心脏手术的成年患者的肾脏预后。