Effect of CVP and IOH on AKI and AKD

Study Overview
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Brief Summary
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This study was aimed to explore the effect of intraoperative venous congestion and intraoperative hypotension (IOH) on acute adverse kidney events, defined as acute kidney injury (AKI) and acute kidney disease (AKD), after cardiac surgery

Detailed Description
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Venous congestion and IOH were primary exposures and quantified as area under the curve (AUC) of central venous pressure ≥12, 16 or 20 mmHg or mean arterial pressure ≤55, 65, 75 mmHg. The primary outcome was AKI or AKD defined as renal dysfunction persisting > 7 days after surgery. Multivariable logistic regression and Cox proportional hazard models were used to determine the association between intraoperative venous congestion/hypotension and postoperative acute adverse kidney events, respectively, adjusted for relevant confounding factors and multiple comparisons.

Official Title
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Venous Congestion Rather Than Intraoperative Hypotension is Associated With Acute Adverse Kidney Events After Cardiac Surgery

Conditions
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Acute Kidney Injury, Acute Kidney Disease

Intervention / Treatment
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* Other: Venous congestion
* Other: Introperation hypotension


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients aged 18 years and older, Patients underwent cardiac surgery (coronary artery bypass grafting, heart valve surgery, heart transplant or surgical excision of intracardiac myxoma) Patients receiving invasive intraoperative BP monitoring during surgery Patients underwent cardiopulmonary bypass (CPB) during surgery Exclusion Criteria: Pre-existing renal insufficiency defined by presence of abnormal preoperative serum creatinine ≥ 133 μmol/L and/or preoperative diagnosis of renal insufficiency within 6 months'preoperative period. Patients with preoperative dialysis dependence within 60 days before the index surgical procedure, Surgical duration less than 30 minutes Surgery on the aorta Insufficient hemodynamic and laboratory data for outcomes and/or exposure ascertainment

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 90 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| CVP ≥ 12<br>central venous pressure ≥12 mmHg | Other: Venous congestion<br>* Venous congestion exposures were quantified as area under the curve (AUC) of central venous pressure ≥12, 16 or 20 mmHg<br>|
| CVP ≥ 16<br>central venous pressure ≥16 mmHg | Other: Venous congestion<br>* Venous congestion exposures were quantified as area under the curve (AUC) of central venous pressure ≥12, 16 or 20 mmHg<br>|
| CVP ≥ 20<br>central venous pressure ≥20 mmHg | Other: Venous congestion<br>* Venous congestion exposures were quantified as area under the curve (AUC) of central venous pressure ≥12, 16 or 20 mmHg<br>|
| MAP ≤ 55 mmHg<br>mean arterial pressure ≤55 mmHg | Other: Introperation hypotension<br>* Introperation hypotension exposures were quantified as area under the curve (AUC) of mean arterial pressure ≤55, 65, 75 mmHg<br>|
| MAP ≤ 65 mmHg<br>mean arterial pressure ≤65 mmHg | Other: Introperation hypotension<br>* Introperation hypotension exposures were quantified as area under the curve (AUC) of mean arterial pressure ≤55, 65, 75 mmHg<br>|
| MAP ≤ 75 mmHg<br>mean arterial pressure ≤75 mmHg | Other: Introperation hypotension<br>* Introperation hypotension exposures were quantified as area under the curve (AUC) of mean arterial pressure ≤55, 65, 75 mmHg<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| CSA-AKI | Cardiovascular surgery associated acute kidney injury. AKI was defined using the Kidney Disease: Improving Global Outcome (KDIGO) Clinical Practice Guideline for Acute Kidney Injury as an absolute increase in serum creatinine of ≥ 26 μmol/L within 48 hours or an increase in serum creatinine beyond 1.5 times the baseline value within 7 days | 7 days post operation | 
| AKD | Acute Kidney Disease, which was defined according to the criteria recommended by the Acute Disease Quality Initiative (ADQI) workgroup.4 AKI was quantified within the 7 days' postoperative period, while AKD was defined as serum creatinine value elevated to 1.5 times the baseline value between 8- and 90-day post-operation period. | 8 to 90 days post operation | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Incidence of AKD of stage 2 and above | incidence of AKD of stage 2 and above, defined as increase in serum creatinine beyond 2.0 times the baseline value between 8- and 90-day post-operation period. | 8 to 90 days post operation | 
| RRT initiation | renal replacement theray (RRT) initiation | from the end of operation to the discharge from hospital, up to 90 days. | 
| value of eGFR | postoperative estimated glomerular filtration rate (eGFR), which was calculated by MDRD Equation. | 7 days after operation | 
| inpatient mortality | mortality during hospital stay | 30 days after inhospital | 
| ICU length of stay | days stay in ICU | from the end of operation to the discharge from ICU, up to 90 days. | 
| length of hospital stay | days stay in hospital | from the end of operation to the discharge from hospital, up to 90 days. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Acute kidney injury, Intraoperative hypotension, Central venous pressure, Acute kidney disease, Cardiopulmonary bypass