TY - JOUR
T1 - Impact of Intraoperative Hypotension During Cardiopulmonary Bypass on Acute Kidney Injury After Coronary Artery Bypass Grafting
AU - Rettig, Thijs C.D.
AU - Peelen, Linda M.
AU - Geuzebroek, Guillaume S.C.
AU - van Klei, Wilton A.
AU - Boer, Christa
AU - van der Veer, Jan Willem
AU - Hofland, Jan
AU - van de Garde, Ewoudt M.W.
AU - Noordzij, Peter G.
PY - 2017/4/1
Y1 - 2017/4/1
N2 - Objective The aim of this study was to investigate whether acute kidney injury (AKI) after coronary artery bypass grafting can be attributed to intraoperative hypotension during cardiopulmonary bypass (IOH-CPB). Design Retrospective analysis. Setting Tertiary-care hospital. Participants Patients undergoing on-pump coronary artery bypass grafting from June 2011 to January 2014. Interventions None. Measurements and Main Results IOH-CPB was defined as blood pressure below several absolute and relative mean arterial pressure (MAP) thresholds and as the area under the curve for absolute MAP thresholds. AKI was defined as an absolute increase in serum creatinine of≥26 µmol/L within 48 hours or an increase to 150% or more within 7 days of surgery. Poisson regression with robust standard errors both before and after adjustment for confounders was used. Of the 1,891 patients included, 386 (20%) developed AKI. In univariable analysis, all IOH-CPB thresholds defined as a MAP of 50 mmHg or less and as a decrease in MAP of 60% from baseline were associated with a 1.07-to-1.11 times increased risk of AKI per 10 minutes of IOH-CPB (p<0.01). After adjustment for potential confounders, IOH-CPB, irrespective of the definition chosen, was not associated with an increased risk of AKI. Conclusions In the authors’ study population, univariable analysis showed an association of IOH-CPB with AKI in patients undergoing isolated CABG, but this relationship disappeared after correction for well-known risk factors for AKI.
AB - Objective The aim of this study was to investigate whether acute kidney injury (AKI) after coronary artery bypass grafting can be attributed to intraoperative hypotension during cardiopulmonary bypass (IOH-CPB). Design Retrospective analysis. Setting Tertiary-care hospital. Participants Patients undergoing on-pump coronary artery bypass grafting from June 2011 to January 2014. Interventions None. Measurements and Main Results IOH-CPB was defined as blood pressure below several absolute and relative mean arterial pressure (MAP) thresholds and as the area under the curve for absolute MAP thresholds. AKI was defined as an absolute increase in serum creatinine of≥26 µmol/L within 48 hours or an increase to 150% or more within 7 days of surgery. Poisson regression with robust standard errors both before and after adjustment for confounders was used. Of the 1,891 patients included, 386 (20%) developed AKI. In univariable analysis, all IOH-CPB thresholds defined as a MAP of 50 mmHg or less and as a decrease in MAP of 60% from baseline were associated with a 1.07-to-1.11 times increased risk of AKI per 10 minutes of IOH-CPB (p<0.01). After adjustment for potential confounders, IOH-CPB, irrespective of the definition chosen, was not associated with an increased risk of AKI. Conclusions In the authors’ study population, univariable analysis showed an association of IOH-CPB with AKI in patients undergoing isolated CABG, but this relationship disappeared after correction for well-known risk factors for AKI.
KW - acute kidney injury
KW - coronary artery bypass grafting
KW - hypotension
KW - outcome
UR - http://www.scopus.com/inward/record.url?scp=84992200612&partnerID=8YFLogxK
U2 - 10.1053/j.jvca.2016.07.040
DO - 10.1053/j.jvca.2016.07.040
M3 - Article
C2 - 27727080
AN - SCOPUS:84992200612
VL - 31
SP - 522
EP - 528
JO - Journal of Cardiothoracic and Vascular Anesthesia
JF - Journal of Cardiothoracic and Vascular Anesthesia
SN - 1053-0770
IS - 2
ER -