This patient's baseline estimated glomerular filtration rate (eGFR) is considered the strongest predictor of the development of acute kidney injury (AKI) in the perioperative period. An elevated preoperative serum creatinine level and the presence of chronic kidney disease (CKD) are the strongest nonmodifiable predictors of the development of AKI after cardiac surgery. This patient has severe kidney disease with an elevated baseline serum creatinine level of 2.3 mg/dL (203.3 µmol/L), with an eGFR of 25 mL/min/1.73 m² and stage 4 CKD. Other nonmodifiable risk factors for post–cardiac surgery AKI include advanced age, female gender, reduced left ventricular function or the presence of heart failure, insulin-dependent diabetes mellitus, peripheral vascular disease, and COPD.

Some observational studies have shown a BMI >30 to be a predictor of AKI post–cardiac surgery. However, the strength of the data is weak, and this patient has a BMI of 25.

Hypertension has not been shown to be a strong predictor for the development of AKI post–cardiac surgery.

Lisinopril and simvastatin have not been established as medications that increase the risk of AKI post–cardiac surgery. In fact, some observational studies indicate that they may have renoprotective properties and should be continued in the perioperative setting.