• Wim Vandenberghe, Thierry Bové, Filip De Somer, Ingrid Herck, Katrien François, Harlinde Peperstraete, Annemieke Dhondt, Thomas Martens, Hannah Schaubroeck, Tine Philipsen, Jens Czapla, Isabelle Claus, Jan J De Waele, and HosteEric A JEAJDepartment of Critical Care Medicine, Ghent University Hospital, Ghent, Belgium; Research Foundation-Flanders (FWO), Brussels, Belgium..
• Department of Critical Care Medicine, Ghent University Hospital, Ghent, Belgium. Electronic address: WimVDB.Vandenberghe@Ugent.be.
• J Crit Care. 2022 Oct 1; 71: 154101.

PurposeLow cardiac output and kidney congestion are associated with acute kidney injury after cardiac surgery (CSA-AKI). This study investigates hemodynamics on CSA-AKI development and reversal.Materials And MethodsAdult patients undergoing cardiac surgery were retrospectively included. Hemodynamic support was quantified using a new time-weighted vaso-inotropic score (VISAUC), and hemodynamic variables expressed by mean perfusion pressure and its components. The primary outcome was AKI stage ≥2 (CSA-AKI ≥2) and secondary outcome full AKI reversal before ICU discharge.Results3415 patients were included. CSA-AKI ≥2 occurred in 37.4%. Mean perfusion pressure (MPP) (OR 0.95,95%CI 0.94-0.96, p < 0.001); and central venous pressure (CVP) (OR 1.17, 95%CI 1.13-1.22, p < 0.001) are associated with CSA-AKI ≥2 development, while VISAUC/h was not (p = 0.104). Out of 1085 CSA-AKI ≥2 patients not requiring kidney replacement therapy, 76.3% fully recovered of AKI. Full CSA-AKI reversal was associated with MPP (OR 1.02 per mmHg (95%CI 1.01-1.03, p = 0.003), and MAP (OR = 1.01 per mmHg (95%CI 1.00-1.02), p = 0.047), but not with VISAUC/h (p = 0.461).ConclusionDevelopment and full recovery of CSA-AKI ≥2 are affected by mean perfusion pressure, independent of vaso-inotropic use. CVP had a significant effect on AKI development, while MAP on full AKI reversal.Copyright © 2022 Elsevier Inc. All rights reserved.

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