Abstract: FR-PO0108
Identifying Blood Pressure Target in Patients with AKI on Continuous Kidney Replacement Therapy
Session Information
- AKI: Epidemiology and Clinical Trials
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Shukr, Maan, West Virginia University, Morgantown, West Virginia, United States
- Al-Mamun, Mohammad A., West Virginia University, Morgantown, West Virginia, United States
- Shawwa, Khaled, West Virginia University, Morgantown, West Virginia, United States
Background
To investigate whether a specific blood pressure target is associated with increased mortality in patients with acute kidney injury (AKI) receiving continuous kidney replacement therapy (CKRT) using hourly mean arterial pressure (MAP).
Methods
Patients were included if they had AKI and underwent CKRT between 1/1/2012-1/1/2021 at a tertiary academic hospital. Norepinephrine equivalent (NEE) dose was calculated to summarize different vasopressors used. Hourly MAPs were used, while the maximum dose of vasopressor during a 6-hour period were used as predictors. We conducted a time-dependent Cox regression model using piecewise linear spline method to identify a break point of MAP.
Results
There were 606 patients with AKI that required CKRT. In-hospital mortality occurred in 285 (47%) patients. Those who died were older (62 vs 57 years), required mechanical ventilation at time of CKRT (80% vs 62%), had higher SOFA score (10.7 vs 9) and lactate (6 vs 3.2 mmol/L).
Higher MAP was associated with lower mortality [HR 0.97 (95%CI:0.97-0.98) per 1 mmHg increase] and higher NEE was associated with higher mortality [HR 5 (95%CI:2.8-8.9) per 0.01 mcg/kg/min increase]. The model was adjusted for vasopressor doses and fluid balance prior to CKRT initiation, time-dependent and vasopressor doses, SOFA score, septic shock, age, sex, Charlson comorbidity index, mechanical ventilation, and baseline lactate. Plotting the MAP values with log-hazard ratio using piecewise linear spline identified MAP of 71.67 mmHg as a point of inflection (figure 1).
Conclusion
Patients with AKI on CKRT may require a higher MAP target. Prospective studies are required to confirm such association.