Abstract P226: Aggressive Blood Pressure Control Status Post-acute Aortic Dissection May be Associated With Acute Kidney Injury: A Pilot Study

Abstract

Management of acute aortic dissection includes appropriate blood pressure control (120/80 mmHg per AHA guidelines) but this is not based on evidence. Excessive lowering of blood pressure may contribute to organ malperfusion. The kidneys are the most commonly affected organs, causing refractory hypertension and acute kidney injury (AKI). Recent landmark blood pressure trials with intensive pressure goals have a significant incidence of AKI. This pilot study tested the hypothesis that achieved systolic blood pressure less than 120 mmHg has a higher incidence of AKI than those treated systolic pressures > 120 mmHg. Methods: Patients were identified via surgical log. Retrospective chart review was performed on patients in the acute setting following dissection. Daily average blood pressures were calculated. Patients were included if they underwent surgical repair of aortic dissection and survived the first 24 hours. Patients were excluded if they demonstrated shock physiology or required renal replacement therapy in the first 24 hours. Serum creatinine and clinical course (including anti-hypertensive regimen) were recorded. The primary endpoint was in-hospital occurrence of AKI (defined per KDIGO criteria) in the acute setting status post aortic dissection in patients receiving anti-hypertensive therapy. An unadjusted odds ratio was calculated. Data on potential confounders and covariates (baseline sCR, contrast exposure etc) were also collected. Results: From 2013-2017, 37 cases of surgically repaired aortic dissection were identified and 16 cases met inclusion/exclusion criteria. The incidence of AKI in patients treated to an average systolic blood pressure less than 120mmHg was 75% compared with 50% in those with pressure greater than 120 mmhg. OR =3.0 [95% CI 0.3612-24.9];p=0.3019. Covariates and potential confounders were balanced between groups but given the small numbers additional statistical adjustments were not performed. Conclusion: The incidence of AKI was numerically higher in the group of patients achieving more intensive blood pressure targets. Our study was limited by small sample size and selection bias. Both of these issues can be addressed if we apply similar methodologies to address the same question on a lager sample size.