Intraoperative vasopressor use and early postoperative acute kidney injury in elderly patients undergoing elective noncardiac surgery

Abstract

Background Intraoperative hypotension is a risk factor for postoperative acute kidney injury (AKI). Elderly patients are susceptible due to reduced responses to acute hemodynamic changes. Aims Determine the association between hypotension identified from anesthetic charts and postoperative AKI in elderly patients. Methods Retrospective cohort study of elective noncardiac surgery patients ≥65 years, at an Australian tertiary hospital (December 2019–March 2021), with the primary outcome of AKI ≤48 h of surgery. Factors of interest were intraoperative hypotension determined from anesthetic charts (mean arterial pressure <60 mmHg, systolic blood pressure <90 mmHg, recorded 5-min) and intraoperative vasopressor use. Results In 830 patients (mean age 75 years), systolic hypotension was more frequent than mean arterial hypotension (25.7% vs. 11.9%). Most hypotensive episodes were brief (7.2% of systolic and 4.2% of mean arterial hypotension lasted >10 min) but vasopressors were used in 84.7% of cases. The incidence of postoperative AKI was 13.9%. Systolic hypotension >20 min was associated with AKI (OR, 3.88; 95% CI: 1.38–10.9), which was not significant after adjusting for vasopressors, creatinine, American Society of Anesthesiologists class, and hemoglobin drop. The cumulative dose of any specific vasopressor >20 mg (or >10 mg epinephrine) was independently associated with AKI (adjusted OR, 2.47; 95% CI: 1.34–4.58). Every 5 mg increase in the total dose of all intraoperative vasopressors used during surgery was associated with 11% increased odds of AKI (95% CI: 3–19%). Conclusions High vasopressor use was associated with postoperative AKI in elderly patients undergoing noncardiac surgery, independent of hypotension identified from anesthetic charts.

Factors associated with acute kidney injury in patients undergoing extracorporeal membrane oxygenation: retrospective cohort

“…For this reason, vasopressors are considered as predictors for AKI, for increasing twice the risk, besides being related to the indication of RRT for prolonged periods ( 19 ) . The association of more than one vasopressor agent or the administration of high doses increases the risk of AKI ( 20 ) . In this study, the relationship between the use of vasopressors, such as vasopressin, and its association with noradrenaline and AKI was confirmed.…”

Fatores associados a lesão renal aguda em pacientes submetidos à oxigenação por membrana extracorpórea: coorte retrospectivo

“…Por esse motivo, os vasopressores são considerados como fatores preditores para LRA, por aumentarem em duas vezes www.scielo.br/reeusp Fatores associados a lesão renal aguda em pacientes submetidos à oxigenação por membrana extracorpórea: coorte retrospectivo Rev Esc Enferm USP • 2023;57:e20220299 Tabela 4 -Análises univariada e multivariada referente ao modelo de regressão logística múltipla para fatores associados a LRA -São Paulo, SP, Brasil, 2021. o risco, além de estarem relacionados à indicação de TSR por períodos prolongados (19) . A associação de mais de um agente vasopressor ou a administração de doses elevadas aumentam o risco para LRA (20) . Neste estudo, se confirmou a relação entre o uso de vasopressores, como a vasopressina, e sua associação com noradrenalina e LRA.…”

Gender differences and risk factors for acute kidney injury following cardiac surgery: A single center retrospective cohort study

“…The cardiac function of patients and the use of certain positive inotropic agents can have an impact on renal perfusion and potentially influence the incidence of AKI [ [45] , [46] , [47] , [48] ]. Due to certain limitations, we were unable to collect information on this aspect.…”