Abstract: SA-PO066
Impact of Standard Mean Arterial Pressure on AKI in Patients with Shock According to Age Groups
Session Information
- AKI Clinical: Biomarkers and Dialysis
November 04, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Acute Kidney Injury
- 003 AKI: Clinical and Translational
Authors
- Atallah, Sarah Y., Staten Island University Hospital, Staten Island, New York, United States
- Zaarour, Mazen, Tulane University, New Orleans, Louisiana, United States
- Weerasinghe, Chanudi, Staten Island University Hospital, Staten Island, New York, United States
- Zaidan, Julie, Staten Island University Hospital, Staten Island, New York, United States
- Kfoury, Bader, Staten Island University Hospital, Staten Island, New York, United States
- Moussaly, Elias, Staten Island University Hospital, Staten Island, New York, United States
- Mahgoub, Ahmed, Staten Island University Hospital, Staten Island, New York, United States
- El-Charabaty, Elie, Staten Island University Hospital, Staten Island, New York, United States
- El Sayegh, Suzanne E., Staten Island University Hospital, Staten Island, New York, United States
Background
Management of mean arterial pressure (MAP) to a target value is crucial in shock. Recent studies advocate the use of higher MAP target in patients in shock who are at risk acute kidney injury (AKI). However, there is limited clinical data to support this approach. Our objective was to compare the AKI outcome in patients with shock according to age and the achieved MAP.
Methods
We performed a retrospective chart review of patients admitted to the Intensive Care Unit (ICU) of one tertiary care center from Jan 2012 to May 2015. We obtained 3 MAP readings per day for the first 3 ICU days (D 0,1,2), with one mean value per day. Patients were stratified into 3 MAP groups (65-70,70-75 and 75-80mmHg). Patients were also grouped according to age (<60 year of agr and ≥60 year of age). The study’s primary outcome was the incidence of AKI according to both age and MAP.
Results
Our sample size included 255 patients (104 <60 y.o, 151 ≥60 y.o). The incidence of AKI was higher in older patients (75.5%) compared to younger ones (69.2%). The incidence of AKI was similar regardless of the achieved MAP (Table 1). Within each age group, MAP did not have an impact on the incidence of AKI (incience of AKI in age <60 on D0: 86.6% in MAP 65-70 mmHg, 73.9% in MAP 70-75 mmHg, 78.9% in MAP 75-80 mmHg, p=0.65; incience of AKI in age≥60 on D0: 67.8% in MAP 65-70 mmHg, 76% in MAP 70-75 mmHg, 75% in MAP 75-80 mmHg, p=0.81). Furthermore, there were no statistically significant differences in the incidence of AKI for all age and MAP groups on all studied days (D0, D1, D2).
Conclusion
Older adults with shock have a higher incidence of AKI compared to younger patients, with no associated reduction in AKI incidence with higher MAP. Larger studies are needed to confirm whether a more conservative MAP target achieves the similar AKI outcomes compared to a higher, more aggressive one.
Table 1: Incidence of AKI across the three mean MAP groups in the total population
| Day 0 | Day 1 | Day 2 | |
| MAP 65-70 | 74.4% | 70.0% | 73.5% |
| MAP 70-75 | 75% | 40.4% | 80% |
| MAP 75-80 | 76.6% | 30.1% | 69.5% |
| p=1 | p=0.97 | p=0.49 |