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

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

Research output: Contribution to journalArticleResearchpeer-review

21 Citations (Scopus)

Abstract

Background: In vasopressor-dependent patients who had undergone cardiovascular surgery, we examined whether those with progression of acute kidney injury (AKI) had a greater difference (deficit) between premorbid and within-ICU hemodynamic pressure-related parameters compared to those without AKI progression. Methods: We assessed consecutive adults who underwent cardiovascular surgery and who stayed in our ICU for at least 48hours and received vasopressor support for more than 4hours. We obtained premorbid and vasopressor-associated, time-weighted average values for hemodynamic pressure-related parameters (systolic [SAP], diastolic [DAP], and mean arterial pressure [MAP]; central venous pressure [CVP], mean perfusion pressure [MPP], and diastolic perfusion pressure [DPP]) and calculated deficits in those values. We defined AKI progression as an increase of at least one Kidney Disease: Improving Global Outcomes stage. Results: We screened 159 patients who satisfied the inclusion criteria and identified 76 eligible patients. Thirty-six patients (47%) had AKI progression. All achieved pressure-related values were similar between patients with or without AKI progression. However, deficits in DAP (P = 0.027), MPP (P = 0.023), and DPP (P = 0.002) were significantly greater in patients with AKI progression. Conclusions: Patients with AKI progression had greater DAP, MPP, and DPP deficits compared to patients without AKI progression. Such deficits might be modifiable risk factors for the prevention of AKI progression.

Original languageEnglish
Article number74
Number of pages8
JournalCritical Care
Volume20
DOIs
Publication statusPublished - 24 Mar 2016
Externally publishedYes

Keywords

  • Acute kidney injury
  • Blood pressure
  • Blood pressure target
  • Critical care
  • Perfusion pressure
  • Relative hypotension

Cite this

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abstract = "Background: In vasopressor-dependent patients who had undergone cardiovascular surgery, we examined whether those with progression of acute kidney injury (AKI) had a greater difference (deficit) between premorbid and within-ICU hemodynamic pressure-related parameters compared to those without AKI progression. Methods: We assessed consecutive adults who underwent cardiovascular surgery and who stayed in our ICU for at least 48hours and received vasopressor support for more than 4hours. We obtained premorbid and vasopressor-associated, time-weighted average values for hemodynamic pressure-related parameters (systolic [SAP], diastolic [DAP], and mean arterial pressure [MAP]; central venous pressure [CVP], mean perfusion pressure [MPP], and diastolic perfusion pressure [DPP]) and calculated deficits in those values. We defined AKI progression as an increase of at least one Kidney Disease: Improving Global Outcomes stage. Results: We screened 159 patients who satisfied the inclusion criteria and identified 76 eligible patients. Thirty-six patients (47{\%}) had AKI progression. All achieved pressure-related values were similar between patients with or without AKI progression. However, deficits in DAP (P = 0.027), MPP (P = 0.023), and DPP (P = 0.002) were significantly greater in patients with AKI progression. Conclusions: Patients with AKI progression had greater DAP, MPP, and DPP deficits compared to patients without AKI progression. Such deficits might be modifiable risk factors for the prevention of AKI progression.",
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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.

In: Critical Care, Vol. 20, 74, 24.03.2016.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Postoperative blood pressure deficit and acute kidney injury progression in vasopressor-dependent cardiovascular surgery patients

AU - Saito, Shinjiro

AU - Uchino, Shigehiko

AU - Takinami, Masanori

AU - Uezono, Shoichi

AU - Bellomo, Rinaldo

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N2 - Background: In vasopressor-dependent patients who had undergone cardiovascular surgery, we examined whether those with progression of acute kidney injury (AKI) had a greater difference (deficit) between premorbid and within-ICU hemodynamic pressure-related parameters compared to those without AKI progression. Methods: We assessed consecutive adults who underwent cardiovascular surgery and who stayed in our ICU for at least 48hours and received vasopressor support for more than 4hours. We obtained premorbid and vasopressor-associated, time-weighted average values for hemodynamic pressure-related parameters (systolic [SAP], diastolic [DAP], and mean arterial pressure [MAP]; central venous pressure [CVP], mean perfusion pressure [MPP], and diastolic perfusion pressure [DPP]) and calculated deficits in those values. We defined AKI progression as an increase of at least one Kidney Disease: Improving Global Outcomes stage. Results: We screened 159 patients who satisfied the inclusion criteria and identified 76 eligible patients. Thirty-six patients (47%) had AKI progression. All achieved pressure-related values were similar between patients with or without AKI progression. However, deficits in DAP (P = 0.027), MPP (P = 0.023), and DPP (P = 0.002) were significantly greater in patients with AKI progression. Conclusions: Patients with AKI progression had greater DAP, MPP, and DPP deficits compared to patients without AKI progression. Such deficits might be modifiable risk factors for the prevention of AKI progression.

AB - Background: In vasopressor-dependent patients who had undergone cardiovascular surgery, we examined whether those with progression of acute kidney injury (AKI) had a greater difference (deficit) between premorbid and within-ICU hemodynamic pressure-related parameters compared to those without AKI progression. Methods: We assessed consecutive adults who underwent cardiovascular surgery and who stayed in our ICU for at least 48hours and received vasopressor support for more than 4hours. We obtained premorbid and vasopressor-associated, time-weighted average values for hemodynamic pressure-related parameters (systolic [SAP], diastolic [DAP], and mean arterial pressure [MAP]; central venous pressure [CVP], mean perfusion pressure [MPP], and diastolic perfusion pressure [DPP]) and calculated deficits in those values. We defined AKI progression as an increase of at least one Kidney Disease: Improving Global Outcomes stage. Results: We screened 159 patients who satisfied the inclusion criteria and identified 76 eligible patients. Thirty-six patients (47%) had AKI progression. All achieved pressure-related values were similar between patients with or without AKI progression. However, deficits in DAP (P = 0.027), MPP (P = 0.023), and DPP (P = 0.002) were significantly greater in patients with AKI progression. Conclusions: Patients with AKI progression had greater DAP, MPP, and DPP deficits compared to patients without AKI progression. Such deficits might be modifiable risk factors for the prevention of AKI progression.

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KW - Blood pressure

KW - Blood pressure target

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