Prevention and Management of Postoperative Acute Kidney Injury in Diabetic Patients

Preoperative Assessment and Risk Stratification

Diabetic patients should undergo preoperative evaluation of renal function using estimated glomerular filtration rate (eGFR) and albumin-to-creatinine ratio (ACR) to assess the risk of postoperative acute kidney injury (AKI) 2, 3
Patients at high risk for AKI can be identified using urinary biomarkers, such as tissue inhibitor of metalloproteinases-2 and insulin-like growth factor-binding protein 7, which can detect kidney stress as early as 1 hour after cardiopulmonary bypass 4
The American Diabetes Association recommends assessing for diabetic chronic kidney disease (DCKD), which significantly increases the risk of postoperative AKI 3

The American Heart Association recommends discontinuing angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) for 48 hours in patients at risk of AKI 4
The American Society of Anesthesiologists recommends avoiding nephrotoxic medications in the perioperative period 2, 3

The American College of Cardiology recommends implementing goal-directed fluid therapy using standardized algorithms to guide administration of fluids, vasopressors, and inotropes to avoid hypotension and low cardiac output 4
The American Society of Anesthesiologists recommends maintaining mean arterial pressure between 60-70 mmHg, or >70 mmHg in hypertensive patients, to ensure adequate renal perfusion 2, 3
The American Diabetes Association recommends monitoring blood glucose levels hourly during surgery and initiating insulin therapy for glucose levels ≥180 mg/dL 1

The American College of Cardiology recommends continuing strict glycemic control postoperatively with target blood glucose <180 mg/dL 1
The American Society of Anesthesiologists recommends implementing early detection strategies for AKI using urinary biomarkers and implementing intervention protocols for at-risk patients 4
The National Institute of Diabetes and Digestive and Kidney Diseases recommends avoiding nephrotoxic agents, maintaining close monitoring of creatinine and urine output, and optimizing volume status and hemodynamic parameters in patients identified as high-risk for AKI 4