• J. Cardiothorac. Vasc. Anesth. · Apr 2017

    Observational Study

    Impact of Intraoperative Hypotension During Cardiopulmonary Bypass on Acute Kidney Injury After Coronary Artery Bypass Grafting.

    • Rettig Thijs C D TCD Department of Anesthesiology, Intensive Care, and Pain Medicine, St. Antonius Hospital, Nieuwegein, Netherlands., Linda M Peelen, Geuzebroek Guillaume S C GSC Department of Cardiothoracic Surgery, Radboud University, Nijmegen, Netherlands., Wilton A van Klei, Christa Boer, Jan Willem van der Veer, Jan Hofland, van de Garde Ewoudt M W EMW Department of Clinical Pharmacy, St. Antonius Hospital, Nieuwegein, Netherlands., and Peter G Noordzij.
    • Department of Anesthesiology, Intensive Care, and Pain Medicine, St. Antonius Hospital, Nieuwegein, Netherlands.
    • J. Cardiothorac. Vasc. Anesth. 2017 Apr 1; 31 (2): 522-528.

    ObjectiveThe aim of this study was to investigate whether acute kidney injury (AKI) after coronary artery bypass grafting can be attributed to intraoperative hypotension during cardiopulmonary bypass (IOH-CPB).DesignRetrospective analysis.SettingTertiary-care hospital.ParticipantsPatients undergoing on-pump coronary artery bypass grafting from June 2011 to January 2014.InterventionsNone.Measurements And Main ResultsIOH-CPB was defined as blood pressure below several absolute and relative mean arterial pressure (MAP) thresholds and as the area under the curve for absolute MAP thresholds. AKI was defined as an absolute increase in serum creatinine of≥26 µmol/L within 48 hours or an increase to 150% or more within 7 days of surgery. Poisson regression with robust standard errors both before and after adjustment for confounders was used. Of the 1,891 patients included, 386 (20%) developed AKI. In univariable analysis, all IOH-CPB thresholds defined as a MAP of 50 mmHg or less and as a decrease in MAP of 60% from baseline were associated with a 1.07-to-1.11 times increased risk of AKI per 10 minutes of IOH-CPB (p<0.01). After adjustment for potential confounders, IOH-CPB, irrespective of the definition chosen, was not associated with an increased risk of AKI.ConclusionsIn the authors' study population, univariable analysis showed an association of IOH-CPB with AKI in patients undergoing isolated CABG, but this relationship disappeared after correction for well-known risk factors for AKI.Copyright © 2017 Elsevier Inc. All rights reserved.

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