Effect of CVP and IOH on AKI and AKD

Nanjing Medical University

Status: Completed

Conditions: Acute Kidney Injury; Acute Kidney Disease

Treatments: Other: Venous congestion; Other: Introperation hypotension

Study type: Observational

Funder types: Other

Identifiers

NCT05222074

KY20211224-09

Details and patient eligibility

About

This study was aimed to explore the effect of intraoperative venous congestion and intraoperative hypotension (IOH) on acute adverse kidney events, defined as acute kidney injury (AKI) and acute kidney disease (AKD), after cardiac surgery

Full description

Venous congestion and IOH were primary exposures and quantified as area under the curve (AUC) of central venous pressure ≥12, 16 or 20 mmHg or mean arterial pressure ≤55, 65, 75 mmHg. The primary outcome was AKI or AKD defined as renal dysfunction persisting > 7 days after surgery. Multivariable logistic regression and Cox proportional hazard models were used to determine the association between intraoperative venous congestion/hypotension and postoperative acute adverse kidney events, respectively, adjusted for relevant confounding factors and multiple comparisons.

Enrollment: 5,127 patients

Sex: All

Ages: 18 to 90 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Patients aged 18 years and older,
• Patients underwent cardiac surgery (coronary artery bypass grafting, heart valve surgery, heart transplant or surgical excision of intracardiac myxoma)
• Patients receiving invasive intraoperative BP monitoring during surgery
• Patients underwent cardiopulmonary bypass (CPB) during surgery

Exclusion criteria

• Pre-existing renal insufficiency defined by presence of abnormal preoperative serum creatinine ≥ 133 μmol/L and/or preoperative diagnosis of renal insufficiency within 6 months'preoperative period.
• Patients with preoperative dialysis dependence within 60 days before the index surgical procedure,
• Surgical duration less than 30 minutes
• Surgery on the aorta
• Insufficient hemodynamic and laboratory data for outcomes and/or exposure ascertainment

Trial design

5,127 participants in 6 patient groups

CVP ≥ 12

Description:

central venous pressure ≥12 mmHg

Treatment:

Other: Venous congestion

CVP ≥ 16

Description:

central venous pressure ≥16 mmHg

Treatment:

Other: Venous congestion

CVP ≥ 20

Description:

central venous pressure ≥20 mmHg

Treatment:

Other: Venous congestion

MAP ≤ 55 mmHg

Description:

mean arterial pressure ≤55 mmHg

Treatment:

Other: Introperation hypotension

MAP ≤ 65 mmHg

Description:

mean arterial pressure ≤65 mmHg

Treatment:

Other: Introperation hypotension

MAP ≤ 75 mmHg

Description:

mean arterial pressure ≤75 mmHg

Treatment:

Other: Introperation hypotension