Postoperative blood pressure deficit and acute kidney injury progression in vasopressor-dependent cardiovascular surgery patients

Saito, Shinjiro; Uchino, Shigehiko; Takinami, Masanori; Uezono, Shoichi; Bellomo, Rinaldo

doi:10.1186/s13054-016-1253-1

Cited by 71 publications

(59 citation statements)

References 25 publications

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“…In addition, a retrospective study of 43,611 patients demonstrated that the occurrence of AKI in hospitalized, previously normotensive adults was independently associated with increased blood pressure during the first 2 years after discharge [21]. However, there are also reports that patients with hypotension are at an increased risk of developing renal failure, decreased renal perfusion aggravate renal function [22,23].…”

Section: Discussionmentioning

confidence: 99%

Risk factors for acute kidney injury among patients with rhabdomyolysis

Yang

Zhou

Wang

et al. 2020

Preprint

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Background Acute kidney injury (AKI) is a life-threatening complication of rhabdomyolysis (RM). The aim of the present study was to assess patients at high risk for the occurrence of AKI defined by the Kidney Disease Improving Global Outcomes criteria and in-hospital mortality. Methods We performed a retrospective study of patients with creatine kinase levels >1000 U/L, who were admitted to the West China Hospital of Sichuan University between January 2011 and March 2019. The sociodemographic, clinical and laboratory data of these patients were obtained from an electronic medical records database, and univariate and multivariate regression analyses were subsequently conducted. Results For the 329 patients included in our study, the incidence of AKI was 61.4%, and the overall mortality rate was 19.8%; furthermore, patients with AKI tended to have higher mortality rates than those without AKI (24.8% vs. 11.8%; P<0.01). The clinical conditions most frequently associated with RM were trauma (28.3%), sepsis (14.6%), bee sting (12.8%), thoracic and abdominal surgery (11.2%) and exercise (7.0%). Furthermore, patients with RM resulting from sepsis, bee sting and acute alcoholism were more susceptible to AKI. The risk factors for the occurrence of AKI among RM patients included age ≥60 years (OR=3.070), chronic alcoholism (OR=3.256), hypertension (OR=4.252), multiple organ dysfunction syndrome (MODS; OR=7.244), high levels of white blood cell count (OR=1.047) and elevated serum phosphorus (OR=5.526). Age ≥60 years (OR=3.188), MODS (OR=2.262), diabetes (OR=2.746) and elevated prothrombin time (OR=1.079) were independent risk factors for in-hospital mortality in RM patients with AKI. Conclusions AKI is independently associated with mortality in patients with RM, and several risk factors were found to be associated with the occurrence of AKI and in-hospital mortality. These findings suggest that, to improve the quality of medical care, the early prevention of AKI should focus on high-risk patients and more effective management.

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Section: Discussionmentioning

confidence: 99%

Risk factors for acute kidney injury among patients with rhabdomyolysis

Yang

Zhou

Wang

et al. 2020

Preprint

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“…However, it is a real clinical contradiction because all of these values are in agreement with the recommended target of the Surviving Sepsis Campaign [30]. In studies investigating abdominal hypertension, RPP is computed as MAP-IAP, while in some cardiological studies, the transrenal pressure gradient is defined as MAP-CVP and supposed to reduce renal blood flow [5, 12, 31, 32]. …”

Section: Discussionmentioning

confidence: 99%

“…Elevated central venous pressure (CVP) and lower diastolic pressure were found in septic ICU patients with AKI in a retrospective study [11]. Another retrospective study conducted in mixed ICU patients showed that the mean perfusion pressure deficit (defined as MAP-CVP) and diastolic perfusion pressure deficit (CVP subtracted from diastolic arterial pressure) is associated with the worsening of renal function (shifts at least one KDIGO-stage) [12]. The elevated CVP has been reported as a stronger predictor of kidney function deterioration than cardiac index in a prospective study conducted in severe heart failure patients [13].…”

Section: Introductionmentioning

confidence: 99%

Renoprotective Postoperative Monitoring: What Is the Best Method for Computing Renal Perfusion Pressure? An Observational, Prospective, Multicentre Study

Kopitkó¹,

Medve²,

Gyökeres

2018

Nephron

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Background: Low mean arterial pressure (MAP) is a well-known risk factor for postoperative acute kidney injury (AKI), but probably it is not the sole hemodynamic parameter that can influence the development of renal failure. There are data in cardiac patients supporting the role of renal venous congestion in the development of AKI. The aim of our study was to determine a combination of factors best predicting the development of AKI. Methods: Data were collected prospectively for adult patients admitted after major abdominal surgery to 9 Hungarian intensive care units. Hemodynamic and laboratory parameters were compared in patients with AKI vs. no-AKI at the time of admission. Renal perfusion was computed by different methods from hemodynamic measurements involving MAP, central venous pressure (CVP), intraabdominal pressure (IAP), and mean airway pressures (Pmean). Twelve different, clinically interpretable equations were tested. Statistical evaluation was performed by the Mann-Whitney U test and ROC analysis. Results: Eighty-four patients were enrolled in the study. Renal perfusion pressure was significantly lower in all equations. The equations MAP-IAP-Pmean (1-area under the curve [AUC]: 0.796; likelihood ratio [LR]+: 3.520; LR–: 0.337; p < 0.01), MAP-IAP-CVP-Pmean (1-AUC: 0.794; LR+: 2.743; LR–: 0.282; p < 0.01), and MAP-2 × IAP-CVP-Pmean (1-AUC: 0.791; LR+: 4.321; LR–: 0.262; p < 0.001) showed small to moderate effect on AKI but have better performance than severity score systems (SAPS II [AUC: 0.696; LR+: 3.143, LR–: 0.433; p < 0.01], SOFA [AUC: 0.717; LR+: 2.089; LR–: 0.528; p < 0.001]). Conclusion: We found that the best parameter predicting AKI is the MAP-2 × IAP-CVP-Pmean. Further investigation is needed to analyze the role of CVP and Pmean, and to characterize renal venous congestion and tubular pressure more in detail.

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“…Also, the sensitivity and specificity of echocardiography to diagnose pulmonary hypertension are modest [28,29]. Nevertheless, pulmonary hypertension and right-heart failure have emerged important risk factors for CSA-AKI, with venous congestion as the common cause [30,31]. Hence, future mechanistic studies investigating therapies mitigating preoperative PSPAP may offer protection against CSA-AKI.…”

Section: Relationship With Previous Studiesmentioning

confidence: 99%

Use of minimally invasive surgery and therapies mitigating pulmonary arterial pressure and intraoperative blood loss may offer protection against cardiac surgery-associated acute kidney injury

Husain‐Syed

Quattrone²,

Ferrari

et al. 2020

Preprint

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Background: Cardiac surgery-associated acute kidney injury (CSA-AKI) is associated with increased morbidity and mortality. We aimed to identify potentially modifiable risk factors for CSA-AKI.Methods: This was a single-center retrospective cohort study of 495 adult patients undergoing cardiac surgery. AKI was diagnosed and staged using full KDIGO criteria incorporating baseline serum creatinine (SC) levels and correction of postoperative SC levels for fluid balance. We examined the association of routinely available clinical and laboratory data with AKI using multivariate logistic regression modeling.Results: A total of 103 (20.8%) patients developed AKI: 16 (15.5%) patients were diagnosed with AKI upon hospital admission, and 87 (84.5%) patients were diagnosed with CSA-AKI. Correction of SC levels for fluid balance increased the number of AKI cases to 104 (21.0%), with six patients categorized to different AKI stages. Univariate logistic regression analysis identified five preoperative (age, sex, diabetes mellitus, preoperative systolic pulmonary arterial pressure (PSPAP), acute decompensated heart failure) and five intraoperative predictors of AKI (age, sex, red blood cell (RBC) volume transfused, use of minimally invasive surgery, duration of cardiopulmonary bypass). When all preoperative and intraoperative variables were incorporated into one model, six predictors remained significant (age, sex, use of minimally invasive surgery, RBC volume transfused, PSPAP, duration of cardiopulmonary bypass). Model-discrimination performance showed an area under the curve of 0.69 for the model including only preoperative variables, 0.76 for the model including only intraoperative variables, and 0.77 for the model including all preoperative and intraoperative variables.Conclusions: Use of minimally invasive surgery and therapies mitigating PSPAP and intraoperative blood loss may offer protection against CSA-AKI. Trial Registration: www.ClinicalTrials.gov (NCT03102528)

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Postoperative blood pressure deficit and acute kidney injury progression in vasopressor-dependent cardiovascular surgery patients

Cited by 71 publications

References 25 publications

Risk factors for acute kidney injury among patients with rhabdomyolysis

Risk factors for acute kidney injury among patients with rhabdomyolysis

Renoprotective Postoperative Monitoring: What Is the Best Method for Computing Renal Perfusion Pressure? An Observational, Prospective, Multicentre Study

Use of minimally invasive surgery and therapies mitigating pulmonary arterial pressure and intraoperative blood loss may offer protection against cardiac surgery-associated acute kidney injury

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