The impact of relative hypotension on acute kidney injury progression after cardiac surgery: a multicenter retrospective cohort study

Annals of Intensive Care

Kazutaka Nogi¹  Akihisa Taguchi²  Koji Kido³  Natsuko Tokuhira⁴  Noriko Mikami⁵  Junji Kumasawa⁶  Tomonao Yoshida⁷  Naoki Yamaguchi⁸  Mami Shibata⁹  Yuki Kotani^1,10  Takuo Yoshida^1,11  Shinsuke Karatsu^1,12  Junichi Izawa^1,13  Masato Nakasone^1,14  Jun Kamei^1,15  Takayuki Kariya^1,16  Takahiro Koga^1,17  Izumi Nakayama^1,18  Hiroshi Nashiki^1,19 

[1] Cardiovascular Medicine, Nara Medical University, Kashihara, Japan;Department of Anesthesiology and Critical Care, Kobe City Medical Center General Hospital, Kobe, Japan;Department of Anesthesiology and Intensive Care Medicine, Hiroshima Citizens Hospital, Hiroshima, Japan;Department of Anesthesiology and Intensive Care, Osaka University Graduate School of Medicine, Suita, Japan;Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan;Department of Critical Care Medicine, Sakai City Medical Center, Sakai, Japan;Department of Emergency Medicine, Hokkaido University Hospital, Sapporo, Japan;Department of Emergency and Critical Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan;Department of Emergency and Critical Care Medicine, Wakayama Medical University, Wakayama, Japan;Department of Intensive Care Medicine, Kameda Medical Center, Kamogawa, Japan;Department of Intensive Care Medicine, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, 162-8666, Tokyo, Japan;Department of Intensive Care Medicine, Yokohama City Minato Red Cross Hospital, Yokohama, Japan;Department of Internal Medicine, Okinawa Prefectural Yaeyama Hospital Okinawa, Ishigaki, Japan;Division of Anesthesiology and Critical Care Medicine, Department of Surgery, Faculty of Medicine, Tottori University, Yonago, Japan;Emergency and Critical Care Center, Kurashiki Central Hospital, Kurashiki, Japan;Intensive Care Department, Yokohama City University Medical Center, Yokohama, Japan;Intensive Care Unit, Department of Anesthesiology, Jikei University School of Medicine, Tokyo, Japan;Intensive Care Unit, Department of Internal Medicine, Okinawa Chubu Hospital, Okinawa, Japan;Intensive Care Unit, Iwate Prefectural Central Hospital, Morioka, Japan;

关键词: Acute kidney injury;    Blood pressure;    Cardiac surgery;    Cardiogenic shock;    Critical care;    Hemodynamics;   

DOI  :  10.1186/s13613-021-00969-4

来源: Springer

【 摘 要 】

BackgroundCardiac surgery is performed worldwide, and acute kidney injury (AKI) following cardiac surgery is a risk factor for mortality. However, the optimal blood pressure target to prevent AKI after cardiac surgery remains unclear. We aimed to investigate whether relative hypotension and other hemodynamic parameters after cardiac surgery are associated with subsequent AKI progression.MethodsWe retrospectively enrolled adult patients admitted to 14 intensive care units after elective cardiac surgery between January and December 2018. We defined mean perfusion pressure (MPP) as the difference between mean arterial pressure (MAP) and central venous pressure (CVP). The main exposure variables were time-weighted-average MPP-deficit (i.e., the percentage difference between preoperative and postoperative MPP) and time spent with MPP-deficit > 20% within the first 24 h. We defined other pressure-related hemodynamic parameters during the initial 24 h as exploratory exposure variables. The primary outcome was AKI progression, defined as one or more AKI stages using Kidney Disease: Improving Global Outcomes’ creatinine and urine output criteria between 24 and 72 h. We used multivariable logistic regression analyses to assess the association between the exposure variables and AKI progression.ResultsAmong the 746 patients enrolled, the median time-weighted-average MPP-deficit was 20% [interquartile range (IQR): 10–27%], and the median duration with MPP-deficit > 20% was 12 h (IQR: 3–20 h). One-hundred-and-twenty patients (16.1%) experienced AKI progression. In the multivariable analyses, time-weighted-average MPP-deficit or time spent with MPP-deficit > 20% was not associated with AKI progression [odds ratio (OR): 1.01, 95% confidence interval (95% CI): 0.99–1.03]. Likewise, time spent with MPP-deficit > 20% was not associated with AKI progression (OR: 1.01, 95% CI 0.99–1.04). Among exploratory exposure variables, time-weighted-average CVP, time-weighted-average MPP, and time spent with MPP < 60 mmHg were associated with AKI progression (OR: 1.12, 95% CI 1.05–1.20; OR: 0.97, 95% CI 0.94–0.99; OR: 1.03, 95% CI 1.00–1.06, respectively).ConclusionsAlthough higher CVP and lower MPP were associated with AKI progression, relative hypotension was not associated with AKI progression in patients after cardiac surgery. However, these findings were based on exploratory investigation, and further studies for validating them are required.Trial Registration UMIN-CTR, https://www.umin.ac.jp/ctr/index-j.htm, UMIN000037074.

【 授权许可】

CC BY