title: Impact of Intraoperative Hypotension During Cardiopulmonary Bypass on Acute Kidney Injury After Coronary Artery Bypass Grafting.
abstract: OBJECTIVE
  The aim of this study was to investigate whether acute kidney injury (AKI) after coronary artery bypass grafting can be attributed to intraoperative hypotension during cardiopulmonary bypass (IOH-CPB).
  
  
  METHODS
  Retrospective analysis.
  
  
  METHODS
  Tertiary-care hospital.
  
  
  METHODS
  Patients undergoing on-pump coronary artery bypass grafting from June 2011 to January 2014.
  
  
  METHODS
  None.
  
  
  RESULTS
  IOH-CPB was defined as blood pressure below several absolute and relative mean arterial pressure (MAP) thresholds and as the area under the curve for absolute MAP thresholds. AKI was defined as an absolute increase in serum creatinine of≥26 µmol/L within 48 hours or an increase to 150% or more within 7 days of surgery. Poisson regression with robust standard errors both before and after adjustment for confounders was used. Of the 1,891 patients included, 386 (20%) developed AKI. In univariable analysis, all IOH-CPB thresholds defined as a MAP of 50 mmHg or less and as a decrease in MAP of 60% from baseline were associated with a 1.07-to-1.11 times increased risk of AKI per 10 minutes of IOH-CPB (p<0.01). After adjustment for potential confounders, IOH-CPB, irrespective of the definition chosen, was not associated with an increased risk of AKI.
  
  
  CONCLUSIONS
  In the authors' study population, univariable analysis showed an association of IOH-CPB with AKI in patients undergoing isolated CABG, but this relationship disappeared after correction for well-known risk factors for AKI.
authors.affiliation: Department of Anesthesiology, Intensive Care, and Pain Medicine, St. Antonius Hospital, Nieuwegein, Netherlands.
authors.forename: Thijs C D
authors.initials: TCD
authors.lastname: Rettig
authors.affiliation: Department of Anesthesiology, Intensive Care, and Emergency Medicine, University Medical Center Utrecht, Utrecht, Netherlands; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands.
authors.forename: Linda M
authors.initials: LM
authors.lastname: Peelen
authors.affiliation: Department of Cardiothoracic Surgery, Radboud University, Nijmegen, Netherlands.
authors.forename: Guillaume S C
authors.initials: GSC
authors.lastname: Geuzebroek
authors.affiliation: Department of Anesthesiology, Intensive Care, and Emergency Medicine, University Medical Center Utrecht, Utrecht, Netherlands.
authors.forename: Wilton A
authors.initials: WA
authors.lastname: van Klei
authors.affiliation: Department of Anesthesiology, Vrije Universiteit University Medical Center, Amsterdam, Netherlands.
authors.forename: Christa
authors.initials: C
authors.lastname: Boer
authors.affiliation: Department of Anesthesiology, Intensive Care, and Pain Medicine, St. Antonius Hospital, Nieuwegein, Netherlands.
authors.forename: Jan Willem
authors.initials: JW
authors.lastname: van der Veer
authors.affiliation: Department of Anesthesiology, Radboud University, Nijmegen, Netherlands.
authors.forename: Jan
authors.initials: J
authors.lastname: Hofland
authors.affiliation: Department of Clinical Pharmacy, St. Antonius Hospital, Nieuwegein, Netherlands.
authors.forename: Ewoudt M W
authors.initials: EMW
authors.lastname: van de Garde
authors.affiliation: Department of Anesthesiology, Intensive Care, and Pain Medicine, St. Antonius Hospital, Nieuwegein, Netherlands. Electronic address: p.noordzij@antoniusziekenhuis.nl.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Noordzij
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology*; D000368:Aged; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000639:trends; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000639:trends; D005260:Female; D006801:Humans; D007022:Hypotension / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology*; D007431:Intraoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology*; D012189:Retrospective Studies
keywords: acute kidney injury; coronary artery bypass grafting; hypotension; outcome