Relation of short-term blood pressure variability to early renal effects in hypertensive patients with controlled blood pressure

Farrag, Hazem Mohammad-Ali; Amin, Amr Salah; Abdel-Rheim, Alaa-Eddin R

doi:10.1097/mbp.0000000000000383

Cited by 13 publications

(10 citation statements)

References 11 publications

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“…A large-scale study on patients undergoing non-cardiac surgery reported a positive correlation of intraoperative MAP variability with the risk of postoperative AKI, regardless of intraoperative hypotension 13 . Similarly, systolic BP variability is negatively correlated with renal function in patients with hypertension 20 , 21 . Renal perfusion is maintained by neurohormonal responses over time 19 , 22 ; therefore, abrupt BP fluctuations may exceed the capacity of such adaptations, which may result in kidney damage.…”

Section: Discussionmentioning

confidence: 97%

Intraoperative mean arterial pressure and acute kidney injury after robot-assisted laparoscopic prostatectomy: a retrospective study

Kim

Shin

et al. 2023

Sci Rep

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Intraoperative hemodynamics can affect postoperative kidney function. We aimed to investigate the effect of intraoperative mean arterial pressure (MAP) as well as other risk factors on the occurrence of acute kidney injury (AKI) after robot-assisted laparoscopic prostatectomy (RALP). We retrospectively evaluated the medical records of 750 patients who underwent RALP. The average real variability (ARV)-MAP, standard deviation (SD)-MAP, time-weighted average (TWA)-MAP, area under threshold (AUT)-65 mmHg, and area above threshold (AAT)-120 mmHg were calculated using MAPs collected within a 10-s interval. Eighteen (2.4%) patients developed postoperative AKI. There were some univariable associations between TWA-MAP, AUT-65 mmHg, and AKI occurrence; however, multivariable analysis found no association. Alternatively, American Society of Anesthesiologists physical status ≥ III and the low intraoperative urine output were independently associated with AKI occurrence. Moreover, none of the five MAP parameters could predict postoperative AKI, with the area under the receiver operating characteristic curve values for ARV-MAP, SD-MAP, TWA-MAP, AUT-65 mmHg, and AAT-120 mmHg being 0.561 (95% confidence interval [CI], 0.424–0.697), 0.561 (95% CI, 0.417–0.704), 0.584 (95% CI, 0.458–0.709), 0.590 (95% CI, 0.462–0.718), and 0.626 (95% CI, 0.499–0.753), respectively. Therefore, intraoperative MAP changes may not be a determining factor for AKI after RALP.

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Section: Discussionmentioning

confidence: 97%

Intraoperative mean arterial pressure and acute kidney injury after robot-assisted laparoscopic prostatectomy: a retrospective study

Kim

Shin

et al. 2023

Sci Rep

View full text Add to dashboard Cite

show abstract

“…A large-scale study on patients undergoing non-cardiac surgery reported a positive correlation of intraoperative MAP variability with the risk of postoperative AKI, regardless of intraoperative hypotension 13 . Similarly, systolic BP variability is negatively correlated with renal function in patients with hypertension 20,21 . Renal perfusion is maintained by neurohormonal responses over time 19,22 ; therefore, abrupt BP uctuations may exceed the capacity of such adaptations, which may result in kidney damage.…”

Section: Discussionmentioning

confidence: 99%

Relationship between intraoperative mean arterial pressure and acute kidney injury after robot-assisted laparoscopic prostatectomy

Kim

Shin

et al. 2022

Preprint

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We aimed to investigate the relationship between intraoperative mean arterial pressure (MAP) and acute kidney injury (AKI) occurrence after robot-assisted laparoscopic prostatectomy (RALP), as well as the relationship between MAP and the maximal increase in serum creatinine (SCr) levels. We retrospectively evaluated the medical records of 750 patients who underwent RALP. The average real variability (ARV)-MAP, standard deviation (SD)-MAP, time-weighted average (TWA)-MAP, area under threshold (AUT)-65 mmHg, and area above threshold (AAT)-120 mmHg were calculated using MAPs collected within a 10-s interval. Eighteen (2.4%) patients developed postoperative AKI. None of the five MAP parameters could predict postoperative AKI, with the area under the receiver operating characteristic curve values for ARV-MAP, SD-MAP, TWA-MAP, AUT-65 mmHg, and AAT-120 mmHg being 0.561 (95% confidence interval [CI], 0.424–0.697), 0.561 (95% CI, 0.417–0.704), 0.584 (95% CI, 0.458–0.709), 0.590 (95% CI, 0.462–0.718), and 0.626 (95% CI, 0.499–0.753), respectively. ARV-MAP (per 15-mmHg/min increase) and TWA-MAP (per 30-mmHg increase) were positively correlated with delta-SCr levels (β = 0.21, P = 0.010 and β = 0.14, P = 0.002; respectively). However, the resulting increases did not cause AKI. Therefore, intraoperative MAP changes may not be a determining factor for AKI after RALP.

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“…Thus, it is feasible that, given more time, urine microalbumin/creatinine ratios may have exceeded the threshold for microalbuminuria in some of our patients. In non‐transplant populations, the literature is conflicting regarding the association between nondipping blood pressure patterns and microalbuminuria, with some studies showing a higher prevalence of microalbuminuria in nondippers and others showing no difference . Potential reasons for the conflicting data include the heterogeneous populations investigated, different definitions of nighttime/daytime used for BP assessment, and varying ways of defining microalbuminuria.…”

Section: Discussionmentioning

confidence: 99%

Relationship between nocturnal blood pressure patterns and end organ damage and diastolic dysfunction in heart transplant recipients

Oreschak

Wolfel

Saba

et al. 2020

Clinical Transplantation

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Background:We assessed the relationship between circadian blood pressure (BP) patterns and clinical outcomes in a contemporary cohort of adult heart transplant recipients.Methods: This retrospective, cross-sectional study included adult heart transplant recipients at least 6 months post-transplant. Ambulatory BP measurements were recorded over 24 hours. Nondippers were defined as a decline in average nighttime BP ≤ 10% compared with daytime. Primary outcomes were the presence of end organ damage, that is, microalbuminuria, chronic kidney disease, and/or left ventricular hypertrophy.Secondary outcomes were measures of diastolic dysfunction (ie, mitral valve deceleration time, e/e′, E/A, and isovolumetric relaxation time), microalbumin/creatinine ratio, eGFR, interventricular septal thickness, and left ventricular posterior wall thickness.Results: Of 30 patients, 53.3% (n = 16) were systolic nondippers and 40% (n = 12) were diastolic nondippers. Diastolic nondippers had three times higher urine microalbumin/creatinine ratios than diastolic dippers (P = .03). Systolic nondippers had 16.3% lower mitral valve deceleration time (P = .05) than systolic dippers, while diastolic nondippers had 20.4% higher e/e′ (P = .05) than diastolic dippers. There were no significant relationships between BP dipping status and any of the primary outcomes.Conclusions: These data suggest that systolic and diastolic nondipping BP patterns are associated with subclinical kidney damage and diastolic dysfunction in heart transplant recipients. K E Y W O R D Sambulatory blood pressure, diastolic dysfunction, end organ damage, heart transplant, nocturnal blood pressure

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Relation of short-term blood pressure variability to early renal effects in hypertensive patients with controlled blood pressure

Cited by 13 publications

References 11 publications

Intraoperative mean arterial pressure and acute kidney injury after robot-assisted laparoscopic prostatectomy: a retrospective study

Intraoperative mean arterial pressure and acute kidney injury after robot-assisted laparoscopic prostatectomy: a retrospective study

Relationship between intraoperative mean arterial pressure and acute kidney injury after robot-assisted laparoscopic prostatectomy

Relationship between nocturnal blood pressure patterns and end organ damage and diastolic dysfunction in heart transplant recipients

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