title: Acute kidney injury following cardiac surgery: role of perioperative blood pressure control.
abstract: OBJECTIVE
  Patients who develop acute kidney injury (AKI) after cardiac surgery continue to have a high mortality rate. Although factors that predispose to postoperative renal dysfunction have been identified, this knowledge has not been associated with a substantial reduction in the incidence of this serious adverse event.
  
  
  METHODS
  This review uses the existing literature to explore the relationship between AKI and perioperative blood pressure (BP) control in cardiac surgery patients. The results of recent novel analyses are introduced, and the implications of these studies for the management of cardiac surgery patients in the perioperative period are discussed.
  
  
  RESULTS
  Preexisting isolated systolic hypertension and wide pulse pressure increase the risk of postoperative renal dysfunction in the cardiac surgery population. New data suggest that BP lability (i.e., BP excursions outside an acceptable physiologic range) during cardiac surgery may also be an important predictor of subsequent renal dysfunction.
  
  
  CONCLUSIONS
  Recently published data suggest that perioperative BP lability influences both the risk of postoperative renal dysfunction and 30-day mortality. Future studies will determine whether the use of agents that allow improved BP control within a desirable range will reduce the incidence of postoperative AKI in cardiac surgery patients.
authors.affiliation: Division of Nephrology, University of Maryland School of Medicine, Baltimore, MD 21201, USA. mweir@medicine.umaryland.edu
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Weir
authors.forename: Solomon
authors.initials: S
authors.lastname: Aronson
authors.forename: Edwin G
authors.initials: EG
authors.lastname: Avery
authors.forename: Charles V
authors.initials: CV
authors.lastname: Pollack
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology*; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000209:etiology* / Q000517:prevention & control; D011183:Postoperative Complications / Q000209:etiology; D011379:Prognosis; D012307:Risk Factors; D013903:Thoracic Surgery; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents