Perioperative Renal Pharmacological Protection During Cardiovascular Surgery

  • Alessandro Belletti
  • Margherita Licheri
  • Tiziana BoveEmail author


Acute kidney injury (AKI) occurs frequently after aortic surgery and is associated with increased perioperative and long-term morbidity and mortality. Patients undergoing aortic surgery are considered at high risk for postoperative AKI both due to surgery-specific factors (e.g., suprarenal aortic cross-clamp) and presence of comorbidities. Despite being less invasive, endovascular procedures also carry a high risk of AKI. Therefore, several pharmacological interventions aimed at preventing or treating have been investigated in recent years.

Unfortunately, up to now, no specific drug has been convincingly found to be effective in reducing AKI incidence or improving disease course, including dopamine, fenoldopam, levosimendan, vasopressin, and diuretics. Avoiding the administration of nephrotoxic drugs, such as nonsteroidal anti-inflammatory drugs, is the most effective preventive strategy, together with general hemodynamic management. The latter include the maintenance of mean arterial pressure (MAP) generally greater than 65 mmHg, avoidance of both hypovolemia and excessive fluid administration, and the maintenance of adequate cardiac output. However, patient management should be individualized depending on the risk of developing AKI. Further research in developing specific strategies for the different risk classes is urgently required.


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Alessandro Belletti
    • 1
  • Margherita Licheri
    • 2
  • Tiziana Bove
    • 3
    Email author
  1. 1.Department of Anesthesia and Intensive CareIRCCS San Raffaele Scientific InstituteMilanItaly
  2. 2.Department of Medical Sciences and Public Health “M. Aresu”University of CagliariCagliariItaly
  3. 3.Department of MedicineUniversity of UdineUdineItaly

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