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January 1, 2024Burns & TraumaOpen Access

Intraoperative hypotension associated with postoperative acute kidney injury in hypertension patients undergoing non-cardiac surgery: a retrospective cohort study

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Key result

Intraoperative mean arterial pressure < 60 mmHg for >20 min (or >10 min if measured invasively) was an independent risk factor for postoperative AKI in hypertension patients.

Why the study?

The total duration and magnitude of intraoperative hypotension associated with postoperative acute kidney injury remained unknown, particularly in chronic hypertension patients undergoing non-cardiac surgery.

Does intraoperative hypotension increase the risk of postoperative acute kidney injury in chronic hypertension patients undergoing non-cardiac surgery?

Population

6552 hypertension patients undergoing non-cardiac surgery

Comparison

Intraoperative hypotension vs no intraoperative hypotension

Design

Retrospective cohort study

Authors

JLJin LiYMYeshuo MaYLYang Li

Discussion

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Member takes

Overview

MAP <60 mmHg for >20 min may signal higher AKI risk in hypertensive noncardiac surgery patients; supports hypothesis-generating thresholds pending randomized trials.

Key Points

  • To investigate the duration and magnitude thresholds of intraoperative hypotension associated with postoperative acute kidney injury in patients with chronic hypertension undergoing non-cardiac surgery.
  • Retrospective cohort study of 6,552 hypertensive patients undergoing non-cardiac surgery between 2011 and 2019 (Trial registration: ChiCTR2100050209).
  • Assessed intraoperative hypotension as the primary exposure and acute kidney injury diagnosed by Kidney Disease: Improving Global Outcomes criteria as the primary outcome using multivariable logistic regression.
  • Postoperative acute kidney injury developed in 8.84% (579/6,552) of patients and was associated with higher ICU admission (3.97% vs. 1.24%, p < 0.001), all-cause mortality (2.76% vs. 0.80%, p < 0.001), and longer hospital stay (13.50 vs. 12.00 days, p < 0.001).
  • Mean arterial pressure < 60 mmHg for > 20 minutes was an independent risk factor for acute kidney injury across the overall cohort.
  • Mean arterial pressure < 60 mmHg for > 10 minutes was an independent risk factor for acute kidney injury in the subgroup with invasive blood pressure monitoring.

Study Design

Type

Cohort (n=6,552)

Structured PICO

Does intraoperative hypotension increase the risk of postoperative acute kidney injury in chronic hypertension patients undergoing non-cardiac surgery?

P
Population
6,552 chronic hypertension patients undergoing non-cardiac surgery evaluated for the relationship between intraoperative hypotension and postoperative acute kidney injury.
E
Exposure
Intraoperative hypotension (mean arterial pressure < 60 mmHg for >20 min non-invasively or >10 min invasively)
O
Outcome
Postoperative acute kidney injury (AKI) as diagnosed with the Kidney Disease-Improving Global Outcomes criteriahard clinical

Intraoperative MAP < 60 mmHg for >20 min (or >10 min invasively) is an independent risk factor for postoperative AKI in hypertensive patients undergoing non-cardiac surgery.

Cite This Study

Li et al. (2024) conducted a cohort in chronic hypertension undergoing non-cardiac surgery (n=6,552). Intraoperative hypotension (MAP < 60 mmHg) was evaluated on Postoperative acute kidney injury (AKI) diagnosed with KDIGO criteria. Intraoperative mean arterial pressure < 60 mmHg for >20 min (or >10 min if measured invasively) was an independent risk factor for postoperative AKI in hypertension patients.

synapsesocial.com/papers/6a71e2b326a7f98052de06dbhttps://doi.org/10.1093/burnst/tkae029
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Intraoperative hypotension is associated with acute kidney injury in noncardiac surgery2017 · 93 citations
  2. 2Intraoperative hypotension and postoperative acute kidney injury in patients undergoing prolonged intra-abdominal surgery: a retrospective, observational study2026
  3. 3Intraoperative Hypertension Is Associated with Postoperative Acute Kidney Injury after Laparoscopic Surgery2023 · 12 citations
  4. 4Postoperative Acute Kidney Injury Associated with Anesthesia Induction in Extremely Hypertensive Patients Undergoing Elective Non-Cardiac Surgery2021
  5. 5Association of intraoperative hypotension and acute kidney injury in noncardiac surgery patients: a post hoc secondary analysis of the EU HYPROTECT registry2025 · 5 citations