RT Book, Section A1 Cheng, Hugo Q. A2 Papadakis, Maxine A. A2 McPhee, Stephen J. A2 Rabow, Michael W. A2 McQuaid, Kenneth R. SR Print(0) ID 1193124486 T1 Perioperative Management of Kidney Disease T2 Current Medical Diagnosis & Treatment 2023 YR 2023 FD 2023 PB McGraw-Hill Education PP New York, NY SN 9781264687343 LK accessmedicine.mhmedical.com/content.aspx?aid=1193124486 RD 2024/03/28 AB Approximately one-third of patients undergoing general surgery will suffer some degree of AKI, and 3% of patients will develop a creatinine elevation greater than 2 mg/dL (176.8 mcmol/L) above baseline or require renal replacement therapy. The development of AKI in patients undergoing general surgery is an independent predictor of mortality, even if mild or if kidney dysfunction resolves. The mortality associated with the development of perioperative AKI that requires dialysis exceeds 50%. Risk factors associated with postoperative deterioration in kidney function are shown in Table 3–7. Several medications, including “renal-dose” dopamine, mannitol, N-acetylcysteine, and clonidine, have not been proved effective in clinical trials to preserve kidney function during the perioperative period and should not be used for this indication. Maintenance of adequate intravascular volume is likely to be the most effective method to reduce the risk of perioperative deterioration in kidney function. Exposure to renal-toxic agents, such as NSAIDs and intravenous contrast, should be minimized or avoided. ACE inhibitors and ARBs reduce renal perfusion and may increase the risk of perioperative AKI. Although firm evidence is lacking, it may be useful to temporarily discontinue these medications in patients at risk for perioperative AKI.