title: Postoperative blood pressure deficit and acute kidney injury progression in vasopressor-dependent cardiovascular surgery patients.
abstract: BACKGROUND
  In vasopressor-dependent patients who had undergone cardiovascular surgery, we examined whether those with progression of acute kidney injury (AKI) had a greater difference (deficit) between premorbid and within-ICU hemodynamic pressure-related parameters compared to those without AKI progression.
  
  
  METHODS
  We assessed consecutive adults who underwent cardiovascular surgery and who stayed in our ICU for at least 48 hours and received vasopressor support for more than 4 hours. We obtained premorbid and vasopressor-associated, time-weighted average values for hemodynamic pressure-related parameters (systolic [SAP], diastolic [DAP], and mean arterial pressure [MAP]; central venous pressure [CVP], mean perfusion pressure [MPP], and diastolic perfusion pressure [DPP]) and calculated deficits in those values. We defined AKI progression as an increase of at least one Kidney Disease: Improving Global Outcomes stage.
  
  
  RESULTS
  We screened 159 patients who satisfied the inclusion criteria and identified 76 eligible patients. Thirty-six patients (47%) had AKI progression. All achieved pressure-related values were similar between patients with or without AKI progression. However, deficits in DAP (P = 0.027), MPP (P = 0.023), and DPP (P = 0.002) were significantly greater in patients with AKI progression.
  
  
  CONCLUSIONS
  Patients with AKI progression had greater DAP, MPP, and DPP deficits compared to patients without AKI progression. Such deficits might be modifiable risk factors for the prevention of AKI progression.
authors.affiliation: Intensive Care Unit, Department of Anesthesiology, Jikei University School of Medicine, 3-19-18, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8471, Japan. shinjiro.saito@gmail.com.
authors.forename: Shinjiro
authors.initials: S
authors.lastname: Saito
authors.affiliation: Intensive Care Unit, Department of Anesthesiology, Jikei University School of Medicine, 3-19-18, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8471, Japan.
authors.forename: Shigehiko
authors.initials: S
authors.lastname: Uchino
authors.affiliation: Intensive Care Unit, Department of Anesthesiology, Jikei University School of Medicine, 3-19-18, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8471, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Takinami
authors.affiliation: Intensive Care Unit, Department of Anesthesiology, Jikei University School of Medicine, 3-19-18, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8471, Japan.
authors.forename: Shoichi
authors.initials: S
authors.lastname: Uezono
authors.affiliation: Department of Intensive Care, Austin Hospital, 145 Studley Road, Melbourne, VIC, 3084, Australia.
authors.forename: Rinaldo
authors.initials: R
authors.lastname: Bellomo
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D000368:Aged; D001794:Blood Pressure / Q000187:drug effects*; D018450:Disease Progression; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007022:Hypotension / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D012151:Resuscitation / Q000379:methods*; D015996:Survival Rate; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D014662:Vasoconstrictor Agents
keywords: Acute kidney injury; Blood pressure; Blood pressure target; Critical care; Perfusion pressure; Relative hypotension