Perioperative Renal Perfusion Pressure Deficits and Risk of Acute Kidney Injury in Cardiac Surgery: A Pilot Study Using Right Heart Catheterization (PRO-AKI).

OBJECTIVES

To evaluate the association between postoperative renal perfusion pressure (RPP) deficit and acute kidney injury (AKI) after cardiac surgery.

DESIGN

A retrospective case-control pilot study.

SETTING

A single academic medical center.

PARTICIPANTS

Data were collected from 486 patients who underwent cardiac surgery requiring cardiopulmonary bypass from July 2018 to March 2024.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN

RESULTS

Preoperative hemodynamics, including (RPP = mean arterial pressure (MAP) - central venous pressure (CVP), which was obtained via right heart catheterization. Postoperative RPP, MAP, and CVP were tracked from postoperative days 0 to 4 and analyzed as percent deficits from preoperative baseline. The primary outcome was AKI progression using the Kidney Disease: Improving Global Outcomes score, and secondary outcomes included adverse events. Among 486 patients, 70 (14.4%) developed AKI. Compared with patients without AKI (416, 85.6%), patients with AKI had a higher percent deficit in RPP (23% v 16%, p < 0.001) and MAP (15% v 8%, p < 0.001). A 10% decrease in average RPP and MAP was associated with a 46% (odds ratio: 1.46, 95% confidence interval: 1.03-2.10, p < 0.036) and 42% (odds ratio: 1.42, 95% confidence interval: 1.16-1.75, p < 0.001) increase in odds of AKI, respectively, adjusted for preoperative hemodynamics and AKI risk factors.

CONCLUSIONS

Greater postoperative decreases in RPP and MAP from preoperative baseline were independently associated with increased AKI risk after cardiac surgery.