Higher blood pressure versus normotension targets to prevent acute kidney injury: a systematic review and meta-regression of randomized controlled trials

Tran, Phu Nguyen Trong; Kusirisin, Prit; Kaewdoungtien, Piyanut; Phannajit, Jeerath; Srisawat, Nattachai

doi:10.1186/s13054-022-04236-1

Cited by 12 publications

(6 citation statements)

References 34 publications

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“…Renal injury is understandable as the threshold for AKI appears to be higher than for myocardial injury, about 75 mm Hg rather than 65 mm Hg. It is also consistent with previous trials evidence for an association between BP control and AKI (92). Data on BP targets before and after cardiopulmonary bypass (CPB) during cardiac surgery are lacking.…”

Section: Hypotension Prediction Index: Internal and External Validationsupporting

confidence: 89%

Hypotension prediction index: From reactive to predictive hemodynamic management, the key to maintaining hemodynamic stability

Ripollés‐Melchor

Ruiz-Escobar

Fernández-Valdes-Bango

et al. 2023

Front. Anesthesiol.

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Intraoperative hypotension is common and has been associated with adverse events, including acute kidney failure, myocardial infarction, and stroke. Since blood pressure is a multidimensional and measurable variable, artificial intelligence and machine learning have been used to predict it. To date, studies have shown that the prediction and prevention of hypotension can reduce the incidence of hypotension. This review describes the development and evaluation of an artificial intelligence predictive algorithm called Hypotension Prediction (HPI), which can predict hypotension up to 15 min before it occurs.

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Section: Hypotension Prediction Index: Internal and External Validationsupporting

confidence: 89%

Hypotension prediction index: From reactive to predictive hemodynamic management, the key to maintaining hemodynamic stability

Ripollés‐Melchor

Ruiz-Escobar

Fernández-Valdes-Bango

et al. 2023

Front. Anesthesiol.

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“…Similar to our ndings, a meta-analysis of RCTs in shock, non-cardiac, and cardiac surgery patients. However, in a subgroup of shock patients with premorbid hypertension, higher MAP target (> 70 mmHg) resulted in signi cantly lower renal replacement therapy needs [25].…”

Section: Discussionmentioning

confidence: 97%

The blood pressure targets in survivors of cardiac arrest: a systematic review and meta- analysis

Xie

Geng

Gao

et al. 2023

Preprint

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Background The patients with return of spontaneous circulation post cardiac arrest have a mortality rate of up to 30-50%. Hemodynamic support is a key component of out-of-hospital cardiac arrest (OHCA) management and is essential to ensure survival. The meta-analysis was performed to investigate the optimizing blood pressure targets in survivors of OHCA. Methods Studies were searched in electronic databases from January 1, 2015 to January 13, 2023. Results were pooled using random effects model and fixed effects model and are presented as odd ratios (ORs) with 95% confidence intervals (CI). The primary outcome was all-cause death and the secondary outcome were severe bleeding, arrhythmia, renal replacement therapy, cerebral performance category (CPC) score≥3, modified Rankin Scale (mRS) score≥4 and the level of serum norepinephrine, neuron-specific enolase (NSE), troponin T.This study was registered with INPLASY 2022120065. Results Four studies involving 1,327 participants were included. No significant differences of the risk of all-cause death were found between the low-target blood pressure and high-target blood pressure strategy (OR 0.93 [95% CI 0.73–1.17], I²=0%, P=0.55). Meanwhile, the low-target blood pressure therapy had a higher proportion of mRS score≥4 (OR 0.43 [95% CI 0.20–0.94], I²=0%, P=0.03) ≥4 compared with the high-target blood pressure therapy. No significant between-group differences were identified among patients in the level of the serum NSE (SD 0.82 [95% CI -1.50–3.13], I²=28%, P=0.49), troponin T (SD 0.54 [95% CI -0.03–1.12], I²=0%, P=0.07), renal replacement therapy (OR 1.09 [95% CI 0.71–1.69], I²=49%, P=0.69), severe bleeding(OR 1.18 [95% CI 0.85–1.65], I²=0%, P=0.33) and arrhythmia(OR 0.84 [95% CI 0.57–1.24], I²=0%, P=0.38). Conclusions The higher mean arterial pressure (MAP) is not associated with improved outcome when compared to conventional target, but may be associated with worse neurological outcome.

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“…The strength of this study is to show the association of BP target with outcomes in patients with established AKI requiring CRRT. Although many clinical studies evaluate the association with BP target and the prevention of AKI (21,22,28), there are few studies that evaluated the effect of BP target on survival and renal outcome. Besides, hemodynamic status including blood pressure is considered when physicians decide the rate of fluid removal by CRRT (29).…”

Section: Discussionmentioning

confidence: 99%

Benefit of higher blood pressure target in severe acute kidney injury (AKI) treated by continuous renal replacement therapy (CRRT)

Matsuura,

Komaru,

Hamasaki

et al. 2023

Shock

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Introduction The optimal target of mean arterial pressure (MAP) during CRRT is unknown. Method We retrospectively collected the hourly MAP data in AKI patients requiring CRRT who admitted to the intensive care unit in the University of Tokyo hospital during 2011-2019. Patients who died within 48 hours of CRRT start and whose average value of hourly MAPs during the first 48 hours was <65 mmHg were excluded. When the average value of MAP was≤75 mmHg or > 75 mmHg, patients were allocated to the low or high target group. We estimated the effect of MAP on mortality and RRT independence at 90-day, using multivariable Cox regression model and Fine and Gray model. Result Of 275 patients we analyzed, 95 patients were in the low group. There are no differences in gender, baseline kidney function, disease severity. At 90 day, the low target group had higher mortality with 38 deaths (40.0%) compared with 57 deaths (31.7%) in the high target group (p < 0.05). The adjusted hazard ratio of the low target group (≤75 mmHg) for mortality was 1.72 (95%CI, 1.08-2.74). In addition, the low target group had lower rate of RRT independence, with 60 (63.2%) patients compared with 136 (75.6%) patients in the high target group (p < 0.05). The multivariable analysis revealed that adjusted hazard ratio of the low target group for RRT independence was 0.74 (95%CI, 0.54-1.01). Conclusion This study found the association with low MAP and mortality. The association with low MAP and delayed renal recovery was not revealed.

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Higher blood pressure versus normotension targets to prevent acute kidney injury: a systematic review and meta-regression of randomized controlled trials

Cited by 12 publications

References 34 publications

Hypotension prediction index: From reactive to predictive hemodynamic management, the key to maintaining hemodynamic stability

Hypotension prediction index: From reactive to predictive hemodynamic management, the key to maintaining hemodynamic stability

The blood pressure targets in survivors of cardiac arrest: a systematic review and meta- analysis

Benefit of higher blood pressure target in severe acute kidney injury (AKI) treated by continuous renal replacement therapy (CRRT)

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