Association of Intraoperative Hypotension with Acute Kidney Injury after Elective Noncardiac Surgery

Sun, Louise Y.; Wijeysundera, Duminda N.; Tait, Gordon; Beattie, W. Scott

doi:10.1097/aln.0000000000000765

Cited by 584 publications

(465 citation statements)

References 29 publications

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“…Our findings were consistent with those reported in previous studies by Walsh et al [9] (average age, approximately 55 years) and Sun et al [10] (average age, approximately 62.9 years). In a retrospective cohort of 18,989 patients who underwent noncardiac procedures, Walsh et al found a graded relationship between more than 5 min spent with a MAP of less than 55 mm Hg or a MAP of 55 mm Hg to 59 mm Hg and stage I AKI.…”

Section: Discussionsupporting

confidence: 83%

“…Sun et al [10] performed another large retrospective analysis regarding the duration of IOH and its effect on AKI. When the intraoperative MAP was less than 60 mm Hg for more than 20 min or less than 55 mm Hg for more than 10 min there was an increased risk of postoperative AKI (defined as a more than 50% or 0.3 mg dL –1 increase in serum creatinine concentration).…”

Section: Introductionmentioning

confidence: 99%

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Association of Intraoperative Hypotension with Acute Kidney Injury after Noncardiac Surgery in Patients Younger than 60 Years Old

Tang

Zhu

Liu

et al. 2019

Kidney Blood Press Res

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Background/Aims: Intraoperative hypotension (IOH) may be associated with surgery-related acute kidney injury (AKI). However, the duration of hypotension that triggers AKI is poorly understood. The incidence of AKI with various durations of IOH and mean arterial pressures (MAPs) was investigated. Materials: A retrospective cohort study of 4,952 patients undergoing noncardiac surgery (2011 to 2016) with MAP monitoring and a length of stay of one or more days was performed. The exclusion criteria were a preoperative estimated glomerular filtration (eGFR) ≤60 mL min^–1 1.73 m^2–1, a preoperative MAP less than 65 mm Hg, dialysis dependence, urologic surgery, age older than 60 years, and a surgical duration of less than 60 min. The primary exposure was IOH, and the primary outcome was AKI (50% or 0.3 mg dL^–1 increase in creatinine) during the first 7 postoperative days. Multivariable logistic regression was used to model the exposure-outcome relationship. Results: AKI occurred in 186 (3.76%) noncardiac surgery patients. The adjusted odds ratio for surgery-related AKI for a MAP of less than 55 mm Hg was 14.11 (95% confidence interval: 5.02–39.69) for an exposure of more than 20 min. Age was not an interaction factor between AKI and IOH. Conclusion: There was a considerably increased risk of postoperative AKI when intraoperative MAP was less than 55 mm Hg for more than 10 min. Strict blood pressure management is recommended even for patients younger than 60 years old.

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Section: Discussionsupporting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Association of Intraoperative Hypotension with Acute Kidney Injury after Noncardiac Surgery in Patients Younger than 60 Years Old

Tang

Zhu

Liu

et al. 2019

Kidney Blood Press Res

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“…Is the method appropriate to investigate the optimal threshold of blood pressure? On the other hand, in patients who underwent non-cardiac surgery, the time spent below intraoperative MAP of 55–60 mm Hg has been strongly associated with increased risk of postoperative AKI [8, 9]. The primary outcome in these studies was not progression to severe-stage AKI, and not all patients were admitted to the ICU.…”

Section: Discussionmentioning

confidence: 99%

“…To assess the association between blood pressure and the progression to stage-3 oliguric AKI, we considered the cumulative hypotension duration as the most clinically relevant variable of blood pressure parameters based on recent studies [8, 9]. Here, we set three hypotension thresholds: MAP of 65, 70, and 75 mm Hg.…”

Section: Methodsmentioning

confidence: 99%

“…Recent studies [4, 5] suggest that maintaining MAP ≥70 mm Hg could better protect patients with sepsis and AKI compared to maintaining MAP ≥65 mm Hg as recommended in the worldwide guidelines for sepsis [6, 7]. Other studies indicate that the time elapsed with blood pressure below threshold might be the key indicator of developing postoperative AKI [8, 9]. On the other hand, the optimal blood pressure threshold is still a matter of debate.…”

Section: Introductionmentioning

confidence: 99%

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Early-phase cumulative hypotension duration and severe-stage progression in oliguric acute kidney injury with and without sepsis: an observational study

et al. 2016

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BackgroundManaging blood pressure in patients with acute kidney injury (AKI) could effectively prevent severe-stage progression. However, the effect of hypotension duration in the early phase of AKI remains poorly understood. This study investigated the association between early-phase cumulative duration of hypotension below threshold mean arterial pressure (MAP) and severe-stage progression of oliguric AKI in critically ill patients, and assessed the difference in association with presence of sepsis.MethodsThis was a single-center, observational study conducted in the ICU of a university hospital in Japan. We examined data from adults with oliguric AKI who were admitted to the ICU during 2010–2014 and stayed in the ICU for ≥24 h after diagnosis of stage-1 oliguric AKI defined in the Kidney Disease Improving Global Outcomes (KDIGO) guidelines. The primary outcome was the progression from stage-1 oliguric AKI to stage-3 oliguric AKI (progression to oligoanuria and use of renal replacement therapy) according to the KDIGO criteria. During the first 6 h after oliguric AKI, we analyzed the association between cumulative time the patient had below threshold MAP (65, 70, and 75 mm Hg) and progression to stage-3.ResultsAmong 538 patients with oliguric AKI, progression to stage-3 increased as the time spent below any threshold MAP was elongated. In the multivariable analysis of all patients, longer hypotension time (3–6 h) showed significant association with stage-3 progression for the time spent below MAP of 65 mm Hg (adjusted odds ratio (OR) 3.73, 95% confidence interval (CI) 1.53–9.09, p = 0.004), but the association was attenuated for the threshold MAP of 70 mm Hg (adjusted OR 2.35, 95% CI 0.96–5.78, p = 0.063) and 75 mm Hg (adjusted OR 1.92, 95% CI 0.72–5.15, p = 0.200). Longer hypotension time with the thresholds of 65 and 70 mm Hg was significantly associated with the risk of stage-3 progression in patients without sepsis, whereas the association was weak and not significant in patients with sepsis.ConclusionsEven in a short time frame (6 h) after oliguric AKI diagnosis, early-phase cumulative hypotension duration was associated with progression to stage-3 oliguric AKI, especially in patients without sepsis.

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Perioperative Management of High-Risk Patients

Aronson

Mythen

2017

JAMA

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Association of Intraoperative Hypotension with Acute Kidney Injury after Elective Noncardiac Surgery

Cited by 584 publications

References 29 publications

Association of Intraoperative Hypotension with Acute Kidney Injury after Noncardiac Surgery in Patients Younger than 60 Years Old

Association of Intraoperative Hypotension with Acute Kidney Injury after Noncardiac Surgery in Patients Younger than 60 Years Old

Early-phase cumulative hypotension duration and severe-stage progression in oliguric acute kidney injury with and without sepsis: an observational study

Perioperative Management of High-Risk Patients

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