Preoperative Risk and the Association between Hypotension and Postoperative Acute Kidney Injury

Conclusions Adult patients undergoing noncardiac surgery demonstrate varying associations with distinct levels of hypotension when stratified by preoperative risk factors. Specific levels of absolute hypotension, but not relative hypotension, are an important independent risk factor for acute kidney injury.Editor ’s PerspectiveWhat We Already Know about This TopicAcute kidney injury occurs in 13% of patients undergoing major surgery and is associated with a six-fold increased risk of mortality.Single-center studies have demonstrated an association between intraoperative hypotension and acute kidney injury.What This Article Tells Us That Is NewIn a large cohort of noncardiac surgical patients, the incidence of acute kidney injury was 9%.Major factors identifying patients at risk for acute kidney injury included anemia, estimated glomerular filtration rate, elevated risk surgery, American Society of Anesthesiologists Physical Status, and expected anesthesia duration.The relationship between hypotension and acute kidney injury varied by underlying patient and procedural risk. Patients with low risk demonstrated no associated increased risk of acute kidney injury across all blood pressure ranges, whereas patients with the highest baseline risk demonstrated an association between even mild absolute intraoperative hypotension ranges and acute kidney injury.

Source: Anesthesiology - February 12, 2020 Category: Anesthesiology Source Type: research