title: Post-operative acute kidney injury in non-suprainguinal vascular surgery patients with a pre-operative history of hypertension.
abstract: Hypertension is an independent predictor of acute kidney injury (AKI) in non-cardiac surgery patients. There are a few published studies which report AKI following non-suprainguinal vascular procedures, but these studies have not investigated predictors of AKI, including anti-hypertensive medications and other comorbidities, in the hypertensive population alone. We sought to identify independent predictors of post-operative AKI in non-suprainguinal vascular surgery patients with a pre-operative history of hypertension. We performed univariate (chi-squared, or Fisher's exact testing) and multivariate (binary logistic regression) statistical analysis of prospectively collected data from 243 adult hypertensive patients who underwent non-suprainguinal vascular surgery (lower limb amputation or peripheral artery bypass surgery) at a tertiary hospital between 2008 and 2011 in an attempt to identify possible associations between comorbidity, acute pre-operative antihypertensive medication administration, and post-operative AKI (a post-operative increase in serum creatinine of ≥ 25 % above the pre-operative measurement) in these patients. The incidence of post-operative AKI in this study was 5.3 % (95 % Confidence Interval: 3.2-8.9 %). Acute pre-operative β-blocker administration was independently associated with post-operative AKI in non-suprainguinal vascular surgery patients with a pre-operative history of hypertension (Odds Ratio: 3.24; 95 % Confidence Interval: 1.03-10.25). The acute pre-operative administration of β-blockers should be carefully considered in non-suprainguinal vascular surgery patients with a pre-operative history of hypertension, in lieu of an increased risk of potentially poor post-operative renal outcomes.
authors.affiliation: Peri-operative Research Group, Department of Anaesthetics, Nelson R. Mandela School of Medicine, University of Kwazulu-Natal, Private Bag X7, Congella 4013, South Africa.
authors.forename: Yoshan
authors.initials: Y
authors.lastname: Moodley
authors.affiliation: Peri-operative Research Group, Department of Anaesthetics, Nelson R. Mandela School of Medicine, University of Kwazulu-Natal, Private Bag X7, Congella 4013, South Africa; Inkosi Albert Luthuli Central Hospital, Durban, South Africa.
authors.forename: Bruce M
authors.initials: BM
authors.lastname: Biccard
keywords: Acute kidney injury; hypertensive; vascular surgery