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CSA-AKI

Cardiac surgery-associated acute kidney injury (CSA-AKI)

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What is CSA-AKI?

Cardiac surgery-associated acute kidney injury (CSA-AKI) occurs when the kidneys suddenly stop functioning normally following heart surgery. There is a higher risk of this complication following procedures that require a cardiopulmonary bypass (CPB), which use a machine to perform the functions of the heart and lungs while blood is directed away from these organs during surgery.1,2

During this procedure, tissues do not receive the appropriate amount of oxygen, which can cause cell damage. In some cases, the return of blood flow “shocks” the cells, leading to more damage. Studies suggest that this cell damage is amplified by inflammation and uncontrolled activation of a part of the immune system known as the complement system, resulting in CSA-AKI.3

Diagnosed prevalence in adults is:

Reference.5 

~35K

In US

~20K

In Europe

~20K

In China

~7K

In Japan

CSA-AKI can lead to permanent kidney dysfunction and damage to other organs, including the brain, heart, liver and lungs.6,7 One-fourth of patients develop AKI post-surgery.8 People with chronic kidney disease (CKD) are at higher risk of developing CSA-AKI. CSA-AKI occurs in up to 50% of people with CKD who undergo cardiac surgery.9

People with CSA-AKI may experience signs and/or symptoms,including:

Reference.10

Nausea

Swelling in legs and around the eyes (oedema)

Shortness of breath

Chest pain or pressure

Fatigue

Confusion

Decreased urine output

CKD patients are more likely to experience negative short- and long-term outcomes following surgery, including worsening of kidney disease, need for kidney replacement therapy and sometimes premature death.11,12

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References

  1. Mao H, et al. Cardiac Surgery-Associated Acute Kidney Injury. Cardiorenal Med. 2013;3:178-199.
  2. Cribben N, et al. Cardiopulmonary bypass. Anaesthesia and Intensive Care Medicine. 2021;22(4):232-237.
  3. Arumugam TV, et al. The role of the complement system in ischemia-reperfusion injury. SHOCK. 2004;21(5):401-409.
  4. Cedzyński M, et al. Editorial: The Role of Complement in Health and Disease. Front Immunol. 2019;10:1869.
  5. AstraZeneca Data on File - Epidemiology estimates are composed of a triangulation of different data sources including Data Monitor, Decision Resources Group, Kantar Health, and internal input (updated as of May 2024).
  6. Brown JK, et al. Adult Cardiac Surgery-Associated Acute Kidney Injury: Joint Consensus Report. Journal of Cardiothoracic and Vascular Anesthesia. 2023;37:1579-1590.
  7. Lee SA, et al. Distant Organ Dysfunction in Acute Kidney Injury: A Review. Am J Kidney Dis. 2018;72:846–856.
  8. Hu J, et al. Global Incidence and Outcomes of Adult Patients with Acute Kidney Injury After Cardiac Surgery: A Systemic Review and Meta-Analysis. J Cardiothorac Vasc Anesth. 2016;30(1):82-89.
  9. Zhang D, et al. Risk Factors and Prognosis of Acute Kidney Injury after Cardiac Surgery in Patients with Chronic Kidney Disease. Blood Purif. 2022;52:166–173.
  10. National Kidney Foundation. Acute kidney injury (AKI). Available from: https://www.kidney.org/atoz/content/Acute KidneyInjury. 2022. Available (Accessed).
  11. Schurle A, et al. CSA-AKI: Incidence, Epidemiology, Clinical Outcomes, and Economic Impact. J Clin Med 2021;10:5746.
  12. Lopez-Delgado JC, et al. Influence of acute kidney injury on short- and long-term outcomes in patients undergoing cardiac surgery: risk factors and prognostic value of a modified RIFLE classification. Critical Care. 2013;17:R293.
  13. Troiano NH, et al. High-Risk & Critical Care Obstetrics Fourth Edition. Chapter 16. AWHONN.
  14. KDIGO. KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney International. 2012;2:124-138.
  15. Castner D. Kidney dialysis. Nursing 2008;38(9):45.
  16. Wu VC, et al. Acute-on-chronic kidney injury at hospital discharge is associated with long-term dialysis and mortality. Kidney Int e2011;80:1222-30.
  17. Xu JR, et al. Risk Factors for Long-Term Mortality and Progressive Chronic Kidney Disease Associated With Acute Kidney Injury After Cardiac Surgery. Medicine (Baltimore). 2015;94(45):e2025.

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