The Beat With Joel Dunning Ep. 142: CKD and CSA-AKI–Addressing the Unmet Need in Cardiac Surgery

This week on The Beat, CTSNet Editor-in-Chief Joel Dunning spoke with Drs. Daniel Engelman, Medical Director of the Cardiac Surgical Critical Care & Inpatient Services at Baystate Health, Professor of Surgery at the University of Massachusetts Chan Medical School—Baystate, and President of the ERAS Cardiac Society, and Marlies Ostermann, consultant in critical care and nephrology at Guy's and St. Thomas Foundation Trust and a Director of Research for the Intensive Care Society, about chronic kidney disease (CKD) and cardiac surgery-associated acute kidney injury (CSA-AKI).  

They delve into the complexities of CSA-AKI, exploring the percentage of patients affected, defining the condition, and highlighting the overall significance of this issue. They also address creatinine as a late marker for AKI, the long-term scarring that can occur from AKI, and the critical need for thorough preoperative assessments to identify high-risk patients. Additionally, they emphasize the importance of a complete health assessment before surgery. Furthermore, they discuss the dangers of reaching stage 3 AKI, the increased costs of care once that point is reached, and what actions to take if a patient has a positive marker but appears stable. They also highlight the premature use of diuretics contributing to AKI and hyperbilirubinemia. Moreover, they consider how CKD along elevates mortality risk and the importance of developing targeted therapies in the future. Finally, they discuss approaches to reduce ischemia-reperfusion (IR) AKI and the optimization of hemodynamics, as well as potential drugs for treating AKI effectively.  

Joel also highlights a recent JANS article on aligning training, patient profiles, and outcomes to redefine success in cardiac surgery in Africa. In addition, he explores the modified root inclusion technique for a fourth sternotomy with Ross/Konno after previous mechanical aortic valve replacement.  

Before closing, Joel highlights upcoming events in CT surgery.   

JANS Items Mentioned 

1.) Redefining Success in Cardiac Surgery in Africa: Aligning Training, Patient Profiles, and Outcomes 

CTSNet Content Mentioned 

1.) Fourth Sternotomy With Ross/Konno After Previous Mechanical Aortic Valve Replacement: The Modified Root Inclusion Technique 

Other Items Mentioned 

1.) Career Center  

2.) CTSNet Events Calendar 

3.) Instructional Video Competition  

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