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Kidney Week

Abstract: TH-PO064

Central Venous Pressure and the Risk of Diuretic-Associated AKI in Patients After Cardiac Surgery

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Mccoy, Ian, Stanford University School of Medicine, Stanford, California, United States
  • Montez-Rath, Maria E., Stanford University School of Medicine, Stanford, California, United States
  • Chertow, Glenn Matthew, Stanford University School of Medicine, Stanford, California, United States
  • Chang, Tara I., Stanford University School of Medicine, Stanford, California, United States
Background

Clinicians strive to weigh the benefits of diuretic therapy for treating and preventing fluid overload against the risks, including acute kidney injury (AKI) due to excessive or overly rapid diuresis. We hypothesized a lower risk of AKI after diuretic administration in patients with higher central venous pressure (CVP) following cardiac surgery.

Methods

We used the MIMIC-III database to study adults admitted to the post-cardiac surgical intensive care unit between 2001 and 2012, excluding those on maintenance dialysis, at an urban academic medical center. Multivariable logistic regression models included adjustments for demographics, comorbidities, admission diagnosis, procedures (cardiopulmonary bypass, coronary artery bypass grafting, left heart catheterization), medications, and severity of illness (mean arterial pressure, admission creatinine, vasopressor use, mechanical ventilation, and platelet count). Inverse probability treatment weighting estimated the risk of diuretic-induced AKI across tertiles of CVP.

Results

Among 4,164 patients receiving intravenous loop diuretics, in contrast to our a priori hypothesis, the adjusted odds of subsequent AKI were 1.11 (95% confidence interval [CI] 1.08-1.13) times higher per mmHg increase in mean CVP on ICU day 1. This association was log-linear across the entire range of CVP observed. The odds ratios were higher for more severe AKI (KDIGO Stage 1: 1.09 (95% CI 1.06-1.11), KDIGO Stage 3: 1.23 (95% CI 1.15-1.31). Among the 5,396 patients including those not on intravenous loop diuretics, the risk ratio for AKI with diuretic use was 1.59 (95% CI 1.39-1.82); results did not materially differ when examined by CVP tertile.

Conclusion

Higher rather than lower CVP is an independent marker of AKI risk. Further research should aim to identify better tools to assess volume status and to determine ICU patient groups for whom diuretics can be most safely administered.

Funding

  • NIDDK Support