{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T14:32:52Z","timestamp":1787581972071,"version":"build-2736575974"},"reference-count":105,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T00:00:00Z","timestamp":1787529600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Cardiac surgery-associated acute kidney injury (CS-AKI) increases short- and long-term mortality, progression to chronic kidney disease (CKD), and healthcare costs. Its pathogenesis is multifactorial\u2014combining renal hypoperfusion, impaired oxygen delivery, hemodilution, inflammation, ischemia\u2013reperfusion injury, and nephrotoxin exposure\u2014so no single intervention confers universal protection. This narrative review appraises fourteen perioperative prevention strategies, grading each by study design, reproducibility, and concordance with contemporary guidelines. The strongest actionable evidence supports the preservation of renal oxygen delivery during cardiopulmonary bypass through goal-directed perfusion, perioperative amino acid infusion, and biomarker-guided Kidney Disease: Improving Global Outcomes (KDIGO) care bundles. Remote ischemic preconditioning, pulsatile flow, minimally invasive extracorporeal circulation, dexmedetomidine, N-acetylcysteine, levosimendan, hemoadsorption with the oXiris membrane, and natriuretic peptides show variable or subgroup-dependent signals limited by heterogeneous trial design and acute kidney injury (AKI) definitions. Prevention of CS-AKI is, therefore, best conceived as a multimodal, patient-centered process integrating preoperative risk stratification, intraoperative oxygen delivery optimization, patient blood management (PBM), and postoperative nephrotoxin avoidance and surveillance.<\/jats:p>","DOI":"10.3390\/jcm15176532","type":"journal-article","created":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T13:20:43Z","timestamp":1787577643000},"page":"6532","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Update on Perioperative Prevention of Cardiac Surgery-Associated Acute Kidney Injury"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0538-1255","authenticated-orcid":false,"given":"Luis","family":"Baeza","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Critical Care, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4958-6108","authenticated-orcid":false,"given":"Pablo","family":"Avanzas","sequence":"additional","affiliation":[{"name":"Heart Area, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain"},{"name":"Instituto de Investigaci\u00f3n Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain"},{"name":"Department of Medicine, University of Oviedo, 33003 Oviedo, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4032-2402","authenticated-orcid":false,"given":"Carla","family":"Delgado-Mart\u00ed","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care, Hospital Universitario Alvaro Cunqueiro, 36312 Vigo, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuel","family":"Garc\u00eda-Delgado","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, Hospital Virgen de las Nieves, 18014 Granada, Spain"},{"name":"Instituto de Investigaci\u00f3n Biosanitaria ibs.GRANADA, 18012 Granada, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Santiago","family":"G\u00f3mez-Estanga","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, Complexo Hospitalario Universitario de A Coru\u00f1a, 15006 A Coru\u00f1a, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-1108-5130","authenticated-orcid":false,"given":"Jos\u00e9 M. L\u00f3pez","family":"Gonz\u00e1lez","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-9793-320X","authenticated-orcid":false,"given":"Pablo","family":"Montero-L\u00f3pez","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care, Cl\u00ednica Universidad de Navarra, 31008 Pamplona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6955-8051","authenticated-orcid":false,"given":"Marc","family":"Vives","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care, Cl\u00ednica Universidad de Navarra, 31008 Pamplona, Spain"},{"name":"Instituto de Investigaci\u00f3n Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1186\/s13054-023-04640-1","article-title":"Prevention of cardiac surgery-associated acute kidney injury: A systematic review and meta-analysis of non-pharmacological interventions","volume":"27","author":"Hariri","year":"2023","journal-title":"Crit. 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