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The impact of relative hypotension on acute kidney injury progression after cardiac surgery: a multicenter retrospective cohort study
BACKGROUND: Cardiac surgery is performed worldwide, and acute kidney injury (AKI) following cardiac surgery is a risk factor for mortality. However, the optimal blood pressure target to prevent AKI after cardiac surgery remains unclear. We aimed to investigate whether relative hypotension and other...
Autores principales: | , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer International Publishing
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8686086/ https://www.ncbi.nlm.nih.gov/pubmed/34928430 http://dx.doi.org/10.1186/s13613-021-00969-4 |
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author | Kotani, Yuki Yoshida, Takuo Kumasawa, Junji Kamei, Jun Taguchi, Akihisa Kido, Koji Yamaguchi, Naoki Kariya, Takayuki Nakasone, Masato Mikami, Noriko Koga, Takahiro Nakayama, Izumi Shibata, Mami Yoshida, Tomonao Nashiki, Hiroshi Karatsu, Shinsuke Nogi, Kazutaka Tokuhira, Natsuko Izawa, Junichi |
author_facet | Kotani, Yuki Yoshida, Takuo Kumasawa, Junji Kamei, Jun Taguchi, Akihisa Kido, Koji Yamaguchi, Naoki Kariya, Takayuki Nakasone, Masato Mikami, Noriko Koga, Takahiro Nakayama, Izumi Shibata, Mami Yoshida, Tomonao Nashiki, Hiroshi Karatsu, Shinsuke Nogi, Kazutaka Tokuhira, Natsuko Izawa, Junichi |
author_sort | Kotani, Yuki |
collection | PubMed |
description | BACKGROUND: Cardiac surgery is performed worldwide, and acute kidney injury (AKI) following cardiac surgery is a risk factor for mortality. However, the optimal blood pressure target to prevent AKI after cardiac surgery remains unclear. We aimed to investigate whether relative hypotension and other hemodynamic parameters after cardiac surgery are associated with subsequent AKI progression. METHODS: We retrospectively enrolled adult patients admitted to 14 intensive care units after elective cardiac surgery between January and December 2018. We defined mean perfusion pressure (MPP) as the difference between mean arterial pressure (MAP) and central venous pressure (CVP). The main exposure variables were time-weighted-average MPP-deficit (i.e., the percentage difference between preoperative and postoperative MPP) and time spent with MPP-deficit > 20% within the first 24 h. We defined other pressure-related hemodynamic parameters during the initial 24 h as exploratory exposure variables. The primary outcome was AKI progression, defined as one or more AKI stages using Kidney Disease: Improving Global Outcomes’ creatinine and urine output criteria between 24 and 72 h. We used multivariable logistic regression analyses to assess the association between the exposure variables and AKI progression. RESULTS: Among the 746 patients enrolled, the median time-weighted-average MPP-deficit was 20% [interquartile range (IQR): 10–27%], and the median duration with MPP-deficit > 20% was 12 h (IQR: 3–20 h). One-hundred-and-twenty patients (16.1%) experienced AKI progression. In the multivariable analyses, time-weighted-average MPP-deficit or time spent with MPP-deficit > 20% was not associated with AKI progression [odds ratio (OR): 1.01, 95% confidence interval (95% CI): 0.99–1.03]. Likewise, time spent with MPP-deficit > 20% was not associated with AKI progression (OR: 1.01, 95% CI 0.99–1.04). Among exploratory exposure variables, time-weighted-average CVP, time-weighted-average MPP, and time spent with MPP < 60 mmHg were associated with AKI progression (OR: 1.12, 95% CI 1.05–1.20; OR: 0.97, 95% CI 0.94–0.99; OR: 1.03, 95% CI 1.00–1.06, respectively). CONCLUSIONS: Although higher CVP and lower MPP were associated with AKI progression, relative hypotension was not associated with AKI progression in patients after cardiac surgery. However, these findings were based on exploratory investigation, and further studies for validating them are required. Trial Registration UMIN-CTR, https://www.umin.ac.jp/ctr/index-j.htm, UMIN000037074. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13613-021-00969-4. |
format | Online Article Text |
id | pubmed-8686086 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Springer International Publishing |
record_format | MEDLINE/PubMed |
spelling | pubmed-86860862021-12-20 The impact of relative hypotension on acute kidney injury progression after cardiac surgery: a multicenter retrospective cohort study Kotani, Yuki Yoshida, Takuo Kumasawa, Junji Kamei, Jun Taguchi, Akihisa Kido, Koji Yamaguchi, Naoki Kariya, Takayuki Nakasone, Masato Mikami, Noriko Koga, Takahiro Nakayama, Izumi Shibata, Mami Yoshida, Tomonao Nashiki, Hiroshi Karatsu, Shinsuke Nogi, Kazutaka Tokuhira, Natsuko Izawa, Junichi Ann Intensive Care Research BACKGROUND: Cardiac surgery is performed worldwide, and acute kidney injury (AKI) following cardiac surgery is a risk factor for mortality. However, the optimal blood pressure target to prevent AKI after cardiac surgery remains unclear. We aimed to investigate whether relative hypotension and other hemodynamic parameters after cardiac surgery are associated with subsequent AKI progression. METHODS: We retrospectively enrolled adult patients admitted to 14 intensive care units after elective cardiac surgery between January and December 2018. We defined mean perfusion pressure (MPP) as the difference between mean arterial pressure (MAP) and central venous pressure (CVP). The main exposure variables were time-weighted-average MPP-deficit (i.e., the percentage difference between preoperative and postoperative MPP) and time spent with MPP-deficit > 20% within the first 24 h. We defined other pressure-related hemodynamic parameters during the initial 24 h as exploratory exposure variables. The primary outcome was AKI progression, defined as one or more AKI stages using Kidney Disease: Improving Global Outcomes’ creatinine and urine output criteria between 24 and 72 h. We used multivariable logistic regression analyses to assess the association between the exposure variables and AKI progression. RESULTS: Among the 746 patients enrolled, the median time-weighted-average MPP-deficit was 20% [interquartile range (IQR): 10–27%], and the median duration with MPP-deficit > 20% was 12 h (IQR: 3–20 h). One-hundred-and-twenty patients (16.1%) experienced AKI progression. In the multivariable analyses, time-weighted-average MPP-deficit or time spent with MPP-deficit > 20% was not associated with AKI progression [odds ratio (OR): 1.01, 95% confidence interval (95% CI): 0.99–1.03]. Likewise, time spent with MPP-deficit > 20% was not associated with AKI progression (OR: 1.01, 95% CI 0.99–1.04). Among exploratory exposure variables, time-weighted-average CVP, time-weighted-average MPP, and time spent with MPP < 60 mmHg were associated with AKI progression (OR: 1.12, 95% CI 1.05–1.20; OR: 0.97, 95% CI 0.94–0.99; OR: 1.03, 95% CI 1.00–1.06, respectively). CONCLUSIONS: Although higher CVP and lower MPP were associated with AKI progression, relative hypotension was not associated with AKI progression in patients after cardiac surgery. However, these findings were based on exploratory investigation, and further studies for validating them are required. Trial Registration UMIN-CTR, https://www.umin.ac.jp/ctr/index-j.htm, UMIN000037074. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13613-021-00969-4. Springer International Publishing 2021-12-20 /pmc/articles/PMC8686086/ /pubmed/34928430 http://dx.doi.org/10.1186/s13613-021-00969-4 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . |
spellingShingle | Research Kotani, Yuki Yoshida, Takuo Kumasawa, Junji Kamei, Jun Taguchi, Akihisa Kido, Koji Yamaguchi, Naoki Kariya, Takayuki Nakasone, Masato Mikami, Noriko Koga, Takahiro Nakayama, Izumi Shibata, Mami Yoshida, Tomonao Nashiki, Hiroshi Karatsu, Shinsuke Nogi, Kazutaka Tokuhira, Natsuko Izawa, Junichi The impact of relative hypotension on acute kidney injury progression after cardiac surgery: a multicenter retrospective cohort study |
title | The impact of relative hypotension on acute kidney injury progression after cardiac surgery: a multicenter retrospective cohort study |
title_full | The impact of relative hypotension on acute kidney injury progression after cardiac surgery: a multicenter retrospective cohort study |
title_fullStr | The impact of relative hypotension on acute kidney injury progression after cardiac surgery: a multicenter retrospective cohort study |
title_full_unstemmed | The impact of relative hypotension on acute kidney injury progression after cardiac surgery: a multicenter retrospective cohort study |
title_short | The impact of relative hypotension on acute kidney injury progression after cardiac surgery: a multicenter retrospective cohort study |
title_sort | impact of relative hypotension on acute kidney injury progression after cardiac surgery: a multicenter retrospective cohort study |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8686086/ https://www.ncbi.nlm.nih.gov/pubmed/34928430 http://dx.doi.org/10.1186/s13613-021-00969-4 |
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