Perioperative Risk Assessment, Prevention, and Treatment of Acute Kidney Injury

There appears to be no single therapy that will prevent perioperative AKI. Clinical risk factors are similar but not identical in different surgical populations. Although developing single therapies that prevent AKI may be possible, they will likely only work populations of patients with specific risk profiles. It is more likely that we will reduce perioperative AKI through better optimization and management of the many comorbidities and hemodynamic derangements that have been shown to impact renal function. As we develop more accurate risk prediction indices for patients in the various surgical settings, we will have the challenge of deciding which patients will receive clinical benefit from our most aggressive and expensive efforts. As surgery is a somewhat predictable and isolated event, the perioperative period is an ideal time to prospectively study our preventive and therapeutic interventions for AKI. © 2009, Lippincott Williams & Wilkins.