Breaking Down the Evidence: Does Perioperative Hypotension Cause Kidney Injury?

Abstract

<b><i>Background:</i></b> Acute kidney injury (AKI) is common in the postoperative period and is associated with negative patient outcomes. The definition of perioperative hypotension is wide, but it is associated with various complications, including AKI. <b><i>Summary:</i></b> Preclinical data suggest that sustained severe renal hypoperfusion per se does not cause persistent AKI. The evidence associating blood pressure levels and postoperative renal dysfunction is predominantly retrospective and observational, and therefore potentially misled by the complex interactions between exposures, confounders, and mediators. <b><i>Key Messages:</i></b> To better understand how perioperative hemodynamic management could affect the occurrence of kidney injury, it is pivotal to further investigate the association between hypotension and kidney dysfunction in the perioperative period and determine the degree to which hypotension is a causal factor.