Anesthesia for Patients with Kidney Disease
Acute kidney injury (AKI) is a common problem, with an incidence of up to 5% in all hospitalized patients and up to 8% in critically ill patients. Post-operative AKI may occur in 1% or more of general surgery patients, and up to 30% of patients un-dergoing cardiothoracic and vascular procedures. Perioperative AKI greatly increases hospitalization costs, mortality rate, and perioperative morbid-ity, including fluid and electrolyte derangements, major cardiovascular events, infection and sepsis, and gastrointestinal hemorrhage. Preoperative risk factors for perioperative AKI include preexisting kidney disease, hypertension, diabetes mellitus, liver disease, sepsis, trauma, hypovolemia, multiple myeloma, and age greater than 55 years. The risk of perioperative AKI is also increased by exposure to nephrotoxic agents such as nonsteroidal antiin-flammatory drugs (NSAIDs), radiocontrast agents, and antibiotics (see Table 29–4).When addressing abnormalities in renal function, the clinician must possess a thorough understanding of the differential diagnosis of AKI (Figure 30–1).