ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: FR-PO017

Postoperative AKI and Intraoperative Mean Arterial Pressure Variability: A Multi-Cohort Observational Study

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Park, Sehoon, Seoul National University Hospital, Seoul, Korea (the Republic of)
  • Kim, Sejoong, Seoul National University Bundang Hospital, Seongnam, GyeonGgi-Do, Korea (the Republic of)
  • Chin, Ho Jun, Seoul National University Bundang Hospital, Seongnam, GyeonGgi-Do, Korea (the Republic of)
  • Kim, Yong Chul, Seoul National University Hospital, Seoul, Korea (the Republic of)
  • Kim, Dong Ki, Seoul National University Hospital, Seoul, Korea (the Republic of)
  • Joo, Kwon Wook, Seoul National University Hospital, Seoul, Korea (the Republic of)
  • Kim, Yon Su, Seoul National University Hospital, Seoul, Korea (the Republic of)
  • Lee, Hajeong, Seoul National University Hospital, Seoul, Korea (the Republic of)
Background

Clinical evidence for the association between intraoperative mean arterial pressure (MAP) variability and the risk of postoperative acute kidney injury (PO-AKI) in non-cardiac surgeries is rare.

Methods

This study included three distinct cohorts in Korea with different time intervals for recording blood pressure during surgery. Non-overlapping first surgery cases were included, excluding those without creatinine measurements or with preexisting renal failure. The main study outcome was PO-AKI, defined by KDIGO serum creatinine criterion cutoffs, and critical AKI, which merged stage 2 KDIGO PO-AKI and post-AKI death or dialysis within 90 days. Standard deviation, coefficient of variation, variation independent of mean, and average real variability were calculated with measured MAP values.

Results

We analyzed 45,575/3,182,502, 29,724/1,354,820, and 7,435/48,923,796 patients/measured MAP values from the three cohorts, respectively. On discovery analysis, the variability parameters were significantly associated with the risk of the studied AKI outcomes, even after adjusted for duration of significant intraoperative hypotension (MAP < 65 mmHg). An increment of 10 mmHg average difference between the measured MAPs, which were measured at a median interval of 2 minutes, was associated with higher risks of PO-AKI [adjusted OR 1.549 (1.307-1.820)] and critical AKI [adjusted OR 1.566 (1.098-2.211)] events. The above results were similar in the other two validation cohorts, and the average real variability was the most significant variability parameter.

Conclusion

High intraoperative MAP variability is an independent risk factor for the risk of PO-AKI and associated patient-oriented outcomes in non-cardiac surgeries.