Acute Kidney Injury Associated With Cardiac Surgery in Adults

Acute kidney injury (AKI) is one of the most serious perioperative complications in patients undergoing cardiac surgery. Due to the complexity of the disease itself, the hemodynamic changes that occur during cardiac surgery, and the patient's underlying comorbidities, cardiac surgery patients are more likely to suffer from renal injury than other surgical patients. Cardiac surgery-associated AKI (CSA-AKI) complicates up to 1/3 of surgeries, leading to many adverse clinical outcomes and a significant increase in treatment costs. Recently, the Perioperative Quality Initiative (POQI) and the Enhanced Recovery After Surgery (ERAS) Cardiac Society jointly developed a consensus on acute kidney injury associated with adult cardiac surgery, aiming to provide professional advice on CSA-AKI for the perioperative team.

Preoperative strategy

Recommendation 1: It is recommended that the health care system take active measures to optimize the renal health and outcomes of patients at high risk of CSA-AKI or who have developed CSA-AKI (evidence not graded; weak recommendation)

Recommendation 2: It is recommended that every patient should undergo a renal health assessment before cardiac surgery, including proteinuria and serum creatinine concentration. (evidence not graded; strong recommendation).

Recommendation 3: Use electronic medical records to promptly identify patients at risk for CSA-AKI and conduct further evaluation in a timely manner. (Level C evidence; weak recommendation).

Recommendation 4: Allow patients to drink clear fluids 2 hours before general anesthesia to reduce the risk of dehydration (Level A evidence; strong recommendation).

Note: For patients with underlying heart failure or delayed gastric emptying, preoperative fluid intake needs to be cautious.

Intraoperative strategy

Recommendation 5: It is recommended that all patients use extracorporeal circulation bundle management to reduce the incidence of CSA-AKI. (Level C evidence; weak recommendation).

Recommendation 6: Maintain adequate intravascular volume in the presence of dynamic fluid shifts and impaired cardiopulmonary function. (Level B evidence; strong recommendation).

Recommendation 7: Do not use excessive ultrafiltration during extracorporeal circulation. (Level C evidence; strong recommendation)

Recommendation 8: Use individualized perioperative goal-directed therapy to reduce the incidence of CSA-AKI (Level B evidence; strong recommendation).

Postoperative strategy

Recommendation 9: Use bedside ultrasound to enhance the assessment of postoperative intravascular volume status (Level C evidence; weak recommendation).

Recommendation 10: Use a urine biomarker-driven care bundle strategy in the postoperative period to enhance kidney health assessment and reduce postoperative CSA-AKI (level C evidence; weak recommendation).

Recommendation 11: Prophylactic or routine use of diuretics is not recommended. (level A evidence; strong recommendation).

Recommendation 12: New-onset KDIGO stage 2 or 3 CSA-AKI progression should be promptly referred for long-term follow-up (level A evidence; strong recommendation).

Recommendation 13: New-onset, persistent, dialysis-dependent CSA-AKI progression should undergo multidisciplinary evaluation similar to other serious adverse hospital-acquired diseases (ungraded evidence; strong recommendation)

How Does Cistanche Treat Kidney Disease?

Cistanche is a traditional Chinese herbal medicine used for centuries to treat various health conditions, including kidney disease. It is derived from the dried stems of Cistanche deserticola, a plant native to the deserts of China and Mongolia. The main active components of cistanche are phenylethanoid glycosides, echinacoside, and acteoside, which have been found to have beneficial effects on kidney health.

Kidney disease, also known as renal disease, refers to a condition in which the kidneys are not functioning properly. This can result in a buildup of waste products and toxins in the body, leading to various symptoms and complications. Cistanche may help treat kidney disease ase through several mechanisms.

Firstly, cistanche has been found to have diuretic properties, meaning it can increase urine production and help eliminate waste products from the body. This can help relieve the burden on the kidneys and prevent the buildup of toxins. By promoting diuresis, cistanche may also help Reduce high blood pressure, a common complication of kidney disease.

Moreover, cistanche has been shown to have antioxidant effects. Oxidative stress, caused by an imbalance between the production of free radicals and the body's antioxidant defenses, plays a key role in the progression of kidney disease. ies help neutralize free radicals and reduce Oxidative stress, thereby protecting the kidneys from damage. The phenylethanoid glycosides found in cistanche have been particularly effective in scavenging free radicals and inhibiting lipid peroxidation.

Additionally, cistanche has been found to have anti-inflammatory effects. Inflammation is another key factor in the development and progression of kidney disease. Cistanche's anti-inflammatory properties help reduce the production of pro-inflammatory cytokines and inhibit the activation of inflammation mandatory pathways, thus alleviating inflammation in the kidneys.

Furthermore, cistanche has been shown to have immunomodulatory effects. In kidney disease, the immune system can be dysregulated, leading to excessive inflammation and tissue damage. Cistanche helps regulate the immune response by modulating the production and activity of immune cells, such as T cells and macrophages. This immune regulation helps reduce inflammation and prevent further damage to the kidneys.

Moreover, cistanche has been found to improve renal function by promoting the regeneration of renal tubes with cells. Renal tubular epithelial cells play a crucial role in the filtration and reabsorption of waste products and electrolytes. In kidney disease, these cells can be damaged, leading to damaged renal function. Cistanche's ability to promote the regeneration of these cells helps restore proper renal function and improve overall kidney health.

In addition to these direct effects on the kidneys, cistanche has been found to have beneficial effects on other organs and systems in the body. This holistic approach to health is particularly important in kidney disease, as the condition often affects multiple organs and systems. che has been shown to have protective effects on the liver, heart, and blood vessels, which are commonly affected by kidney disease. By promoting the health of these organs, cistanche helps improve overall kidney function and prevent further complications.

In conclusion, cistanche is a traditional Chinese herbal medicine used for centuries to treat kidney disease. Its active components have diuretic, antioxidant, anti-inflammatory, immunomodulatory, and regenerative effects, which help improve renal function and protect the kidneys from further damage. , cistanche has beneficial effects on other organs and systems, making it a holistic approach to treating kidney disease.