Intraoperative hypotension and postoperative acute kidney injury: A systematic review

• Published in: The American journal of surgery Vol. 232; pp. 45 - 53
• Main Authors: Penev, Yordan, Ruppert, Matthew M., Bilgili, Ahmet, Li, Youlei, Habib, Raiya, Dozic, Abdul-Vehab, Small, Coulter, Adiyeke, Esra, Ozrazgat-Baslanti, Tezcan, Loftus, Tyler J., Giordano, Chris, Bihorac, Azra
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2024; Elsevier Limited
• Subjects: Acute kidney injury; Acute Kidney Injury - epidemiology; Acute Kidney Injury - etiology; Acute Kidney Injury - prevention & control; AKI; Blood pressure; Case studies; Heart surgery; Hemodynamics; Hospital costs; Humans; Hypotension; Hypotension - epidemiology; Hypotension - etiology; Hypotension - prevention & control; Intraoperative Complications - epidemiology; Intraoperative Complications - etiology; Intraoperative Complications - prevention & control; Intraoperative hemodynamics; Intraoperative hypotension; Kappa coefficient; Kidneys; Mortality; Patients; Postoperative complications; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Postoperative Complications - prevention & control; Risk factors; Subject heading schemes; Surgeons; Surgery complications; Systematic review; Thresholds; Trauma; Surgery complications; Intraoperative hypotension; Acute kidney injury; Intraoperative hemodynamics; Postoperative complications; AKI
• ISSN: 0002-9610; 1879-1883; 1879-1883
• DOI: 10.1016/j.amjsurg.2024.02.001

There is no consensus regarding safe intraoperative blood pressure thresholds that protect against postoperative acute kidney injury (AKI). This review aims to examine the existing literature to delineate safe intraoperative hypotension (IOH) parameters to prevent postoperative AKI. PubMed, Cochrane Central, and Web of Science were systematically searched for articles published between 2015 and 2022 relating the effects of IOH on postoperative AKI. Our search yielded 19 articles. IOH risk thresholds ranged from <50 to <75 ​mmHg for mean arterial pressure (MAP) and from <70 to <100 ​mmHg for systolic blood pressure (SBP). MAP below 65 ​mmHg for over 5 ​min was the most cited threshold (N ​= ​13) consistently associated with increased postoperative AKI. Greater magnitude and duration of MAP and SBP below the thresholds were generally associated with a dose-dependent increase in postoperative AKI incidence. While a consistent definition for IOH remains elusive, the evidence suggests that MAP below 65 ​mmHg for over 5 ​min is strongly associated with postoperative AKI, with the risk increasing with the magnitude and duration of IOH. •Postoperative AKI is most commonly defined by KDIGO criteria.•MAP <65 ​mmHg is the most common definition of IOH associated with postoperative AKI.•5+ minutes below MAP of 65 ​mmHg is associated with higher OR for postoperative AKI.•In noncardiac surgery, the relation between IOH & postoperative AKI is dose-dependent.•In cardiac surgery, IOH contributes to postoperative AKI in a dose-independent manner.