Potential Renoprotective Strategies in Adult Cardiac Surgery: A Survey of Society of Cardiovascular Anesthesiologists Members to Explore the Rationale and Beliefs Driving Current Clinical Decision-Making.

Abstract Objectives We sought to i) characterize the rationale underpinning anesthesiologists use of various perioperative strategies hypothesized to impact renal function in adult patients undergoing cardiac surgery, ii) characterize existing belief about the quality of evidence addressing the renal impact of these strategies, and iii) identify potentially reno-protective strategies for which anesthesiologists would most value a detailed, evidence-based review. Design Survey of perioperative practice in adult patients undergoing cardiac surgery. Setting On-line survey. Participants Members of the Society of Cardiovascular Anesthesiologists (SCA). Interventions None Measurements & Main Results The survey was distributed to more than 2000 SCA members and completed in whole or in part by 202 respondents. Selection of target intraoperative blood pressure (and relative hypotension avoidance) was the strategy most frequently reported to reflect belief about its potential renal effect (79%; 95% CI 72-85%). Most respondents believed the evidence supporting an effect on renal injury of intraoperative target blood pressure during cardiac surgery was of high or moderate quality. Other factors, including a specific non-renal rationale, surgeon preference, department- or institution-level decisions, tradition or habit were also frequently reported to impact decision making across queried strategies. Potentially reno-protective strategies most frequently requested for inclusion in a subsequent detailed, evidence-based review were intraoperative target blood pressure and choice of vasopressor agent to achieve target pressure. Conclusions A large number of perioperative strategies are variably believed to impact renal injury in adult patients undergoing cardiac surgery, with wide variation in perceived quality of evidence for a renal effect of these strategies.