BACKGROUND Patients with chronic kidney disease who require maintenance dialysis suffer excess morbidity and mortality for reasons that are not clearly elucidated. There are few targets for intervention to improve their outcomes. The authors hypothesized that perioperative hypotension is more common in patients receiving dialysis. METHODOLOGY A retrospective cohort study was conducted of adult patients who had inpatient noncardiac surgery lasting greater than 2 h with general anesthesia between January 2012 and December 2021 at the Cleveland Clinic (Cleveland, Ohio). Using International Classification of Diseases codes and dialysis documentation in the electronic medical record, was derived age, American Society of Anesthesiologists (Schaumburg, Illinois) Physical Status, surgery type, and propensity score (predicting dialysis dependence) matched groups of patients (1) with dialysis-dependent chronic kidney disease, (2) with nondialysis chronic kidney disease, and (3) without kidney disease. The primary outcomes were total area under the curve of mean arterial pressure (MAP) less than 65 mmHg during the surgery and postoperative MAP less than 70 mmHg during 48 h after surgery. RESULTS Three 1:1:1 matched groups of 1,886 patients (total, 5,658 patients) from an overall cohort of 123,761 were derived. Cases with dialysis-dependent kidney disease had a greater intraoperative area under the curve of MAP less than 65 mmHg (difference in medians, 18.4 mmHg-min 98.75% CI, 11.3 to 25.6; P < 0.001) when compared to patients who had nondialysis kidney disease and when compared to patients without kidney disease (difference in medians, 15.5 mmHg-min; 98.75% CI, 6.6 to 24.4; P < 0.001). Patients receiving preoperative dialysis were also more likely to have postoperative MAP less than 70 mmHg compared to patients with nondialysis kidney disease (rate ratio, 1.52; 98.75% CI, 1.48 to 1.57; P < 0.0001) and compared to patients without kidney disease (rate ratio, 1.43; 98.75% CI, 1.38 to 1.47; P < 0.0001). CONCLUSIONS Perioperative hypotension is more severe and common among patients who undergo chronic maintenance dialysis compared to similar patients without dialysis dependence. The management of hemodynamics in this population comes with unique considerations that warrant further systematic evaluation. EDITOR’S PERSPECTIVE

中文翻译：

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接受非心脏手术的慢性肾病透析患者围手术期低血压：一项回顾性队列研究。


背景 需要维持透析的慢性肾病患者的发病率和死亡率过高，原因尚不清楚。几乎没有干预目标可以改善他们的结局。作者假设围手术期低血压在接受透析的患者中更为常见。方法： 对 2012 年 1 月至 2021 年 12 月期间在克利夫兰诊所（俄亥俄州克利夫兰）接受住院非心脏手术超过 2 小时且全身麻醉的成年患者进行了一项回顾性队列研究。使用电子病历中的国际疾病分类代码和透析文件，得出年龄、美国麻醉医师协会（伊利诺伊州绍姆堡）身体状况、手术类型和倾向评分（预测透析依赖性）匹配的患者组 （1） 透析依赖性慢性肾病，（2） 非透析慢性肾病，以及 （3） 无肾病。主要结局为术后 48 h 平均动脉压 （MAP） 小于 65 mmHg 和术后 MAP 小于 70 mmHg 的总曲线下面积。结果 从整个队列 1,886 名患者 （总共 5,658 名） 中得出三个 1：1：1 匹配组 （总计 5,658 名患者）。透析依赖性肾病病例在 MAP 曲线下面积小于 65 mmHg 较大（中位数差异，18.4 mmHg-min 98.75% CI，11.3 至 25.6;P < 0.001），与患有非透析肾病的患者和无肾病患者（中位数差异，15.5 mmHg-min;98.75% CI，6.6 至 24.4;P < 0.001）。 与非透析肾病患者相比，接受术前透析的患者术后 MAP 低于 70 mmHg 的可能性也更大（率比，1.52;98.75% CI，1.48 至 1.57;P < 0.0001），并与无肾病患者相比 （率比，1.43;98.75% CI，1.38 至 1.47;P < 0.0001）.结论 与无透析依赖的类似患者相比，接受慢性维持透析的患者围手术期低血压更严重和常见。该人群的血流动力学管理具有独特的考虑因素，需要进一步系统评估。编辑观点