Postoperative diastolic perfusion pressure is associated with the development of acute kidney injury in patients after cardiac surgery: a retrospective analysis

Jifu Jin,Su Chi Chang,Yamin Zhuang,Jiawei Yu,Sujuan Xu,Jiarui Xu,Jie Teng,Bo Shen,Xiaoqiang Ding,Wuhua Jiang,Chunsheng Wang

doi:10.1186/s12882-019-1632-3

Abstract

BackgroundWe aimed to investigate the relationship between the perioperative hemodynamic parameters and the occurrence of cardiac surgery-associated acute kidney injury.MethodsA retrospective study was performed in patients who underwent cardiac surgery at a tertiary referral teaching hospital. Acute kidney injury was determined according to the KDIGO criteria. We investigated the association between the perioperative hemodynamic parameters and cardiac surgery-associated acute kidney injury to identify the independent hemodynamic predictors for acute kidney injury. Subgroup analysis was further performed in patients with chronic hypertension.ResultsAmong 300 patients, 29.3% developed acute kidney injury during postoperative intensive care unit period. Multivariate logistic analysis showed the postoperative nadir diastolic perfusion pressure, but not mean arterial pressure, central venous pressure and mean perfusion pressure, was independently linked to the development of acute kidney injury after cardiac surgery (odds ratio 0.945, P = 0.045). Subgroup analyses in hypertensive subjects (n = 91) showed the postoperative nadir diastolic perfusion pressure and peak central venous pressure were both independently related to the development of acute kidney injury (nadir diastolic perfusion pressure, odds ratio 0.886, P = 0.033; peak central venous pressure, odds ratio 1.328, P = 0.010, respectively).ConclusionsPostoperative nadir diastolic perfusion pressure was independently associated with the development of cardiac surgery-associated acute kidney injury. Furthermore, central venous pressure should be considered as a potential hemodynamic target for hypertensive patients undergoing cardiac surgery.

Highlights

We aimed to investigate the relationship between the perioperative hemodynamic parameters and the occurrence of cardiac surgery-associated acute kidney injury
Acute Physiology and Chronic Health Evaluation III (APACHE III) score, EuroSCORE II at intensive care unit (ICU) admission, and surgery types were comparable in different patient groups
After adjusting for risk factors for Acute kidney injury (AKI), the upper limits of the range (ULR) value of central venous pressure (CVP) and the lower limits of the range (LLR) value of diastolic perfusion pressure (DPP) were both significantly and independently associated with AKI occurrence (OR for 1 mmHg increase of CVP [ULR] = 1.328, 95% confidence interval (CI): 1.070–1.648, P = 0.010; odds ratio (OR) for 1 mmHg increase of DPP [LLR] = 0.886, 95% CI: 0.793–0.990, P = 0.010) (Table 5)

Summary

Introduction

We aimed to investigate the relationship between the perioperative hemodynamic parameters and the occurrence of cardiac surgery-associated acute kidney injury. Acute kidney injury (AKI) is a frequent and severe complication after cardiac surgery, which has shown to be related to the increased morbidity, mortality and resource utilization [1,2,3,4]. Multiple studies have identified risk factors for CSA-AKI that cannot be modified, including age, gender, baseline kidney function, diabetes mellitus and hypertension [6]. Hemodynamic parameters, as modifiable risk factors, may be related to the progression of AKI in high-risk patients [7,8,9,10,11]. A number of studies have reported that an increased central venous pressure (CVP) is linked to the venous congestion and deterioration of kidney function in patients with cardiovascular disease

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