Background Acute kidney injury (AKI) is a common surgical complication and is associated with intraoperative hypotension. However, the total duration and magnitude of intraoperative hypotension associated with AKI remains unknown. In this study, the causal relationship between the intraoperative arterial pressure and postoperative AKI was investigated among chronic hypertension patients undergoing non-cardiac surgery. Methods A retrospective cohort study of 6552 hypertension patients undergoing non-cardiac surgery (2011 to 2019) was conducted. The primary outcome was AKI as diagnosed with the Kidney Disease-Improving Global Outcomes criteria and the primary exposure was intraoperative hypotension. Patients’ baseline demographics, pre- and post-operative data were harvested and then analyzed with multivariable logistic regression to assess the exposure–outcome relationship. Results Among 6552 hypertension patients, 579 (8.84%) had postoperative AKI after non-cardiac surgery. The proportions of patients admitted to ICU (3.97 vs. 1.24%, p < 0.001) and experiencing all-cause death (2.76 vs. 0.80%, p < 0.001) were higher in the patients with postoperative AKI. Moreover, the patients with postoperative AKI had longer hospital stays (13.50 vs. 12.00 days, p < 0.001). Intraoperative mean arterial pressure (MAP) < 60 mmHg for >20 min was an independent risk factor of postoperative AKI. Furthermore, MAP <60 mmHg for >10 min was also an independent risk factor of postoperative AKI in patients whose MAP was measured invasively in the subgroup analysis. Conclusions Our work suggested that MAP < 60 mmHg for >10 min measured invasively or 20 min measured non-invasively during non-cardiac surgery may be the threshold of postoperative AKI development in hypertension patients. This work may serve as a perioperative management guide for chronic hypertension patients. Trial registration clinical trial number: ChiCTR2100050209 (8/22/2021). http://www.chictr.org.cn/showproj.aspx?proj=132277.

中文翻译：

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接受非心脏手术的高血压患者术中低血压与术后急性肾损伤相关：一项回顾性队列研究


背景 急性肾损伤（AKI）是一种常见的手术并发症，并与术中低血压相关。然而，与 AKI 相关的术中低血压的总持续时间和严重程度仍不清楚。本研究在接受非心脏手术的慢性高血压患者中调查了术中动脉压与术后 AKI 之间的因果关系。方法对2011年至2019年6552例接受非心脏手术的高血压患者进行回顾性队列研究。主要结局是根据改善肾脏病全球结局标准诊断的 AKI，主要暴露是术中低血压。收集患者的基线人口统计数据、术前和术后数据，然后使用多变量逻辑回归进行分析，以评估暴露-结果关系。结果 6552例高血压患者中，579例（8.84%）非心脏手术后发生术后AKI。术后发生 AKI 的患者入住 ICU 的患者比例（3.97 vs. 1.24%，p < 0.001）和经历全因死亡（2.76 vs. 0.80%，p < 0.001）的患者比例较高。此外，术后发生 AKI 的患者住院时间较长（13.50 天 vs. 12.00 天，p < 0.001）。术中平均动脉压 (MAP) < 60 mmHg 持续 >20 分钟是术后 AKI 的独立危险因素。此外，在亚组分析中，对于有创测量 MAP 的患者，>10 分钟 MAP <60 mmHg 也是术后 AKI 的独立危险因素。 结论 我们的工作表明，非心脏手术期间有创测量的 MAP < 60 mmHg >10 分钟或无创测量的 20 分钟可能是高血压患者术后发生 AKI 的阈值。该工作可作为慢性高血压患者的围手术期管理指南。试验注册临床试验编号：ChiCTR2100050209（8/22/2021）。 http://www.chictr.org.cn/showproj.aspx?proj=132277。