Background. Postoperative acute kidney injury (AKI) is associated with high mortality and substantial cost after aortocoronary bypass graft (CABG) surgery. We tested the hypothesis that intraoperative systolic blood pressure variation is associated with postoperative AKI. Methods. We gathered demographic, procedural, blood pressure, and renal outcome data for 7,247 CABG surgeries at a single institution between 1996 and 2005. A development/validation cohort methodology was randomly divided (66% and 33%, resp.). Peak postoperative serum creatinine rise relative to baseline (%ΔCr) was the primary AKI outcome variable. Markers reflective of intraoperative systolic blood pressure variation were derived for each patient including (1) peak and nadir values (absolute and relative to baseline) and (2) excursion episodes beyond selected thresholds (by duration, frequency, and duration × degree). Each marker of systolic blood pressure variation was then separately evaluated for association with AKI using linear regression models with adjustment for several known risk factors (age, aprotinin use, congestive heart failure, previous myocardial infarction, baseline creatinine, bypass time, diabetes, weight, concomitant valve surgery, gender, and preoperative pulse pressure). Results. An association was identified between systolic blood pressure relative to baseline and postoperative AKI ( ). Conclusions. In CABG surgery patients, intraoperative systolic blood pressure decrease relative to baseline systolic blood pressure is independently associated with postoperative AKI. 1. Introduction It is commonly purported that poor perioperative hemodynamic control during cardiac surgery leads to postoperative acute kidney injury (AKI) [1–9]. Systolic blood pressure and pulse pressure amplification are due to changes in arterial stiffness that affect wave propagation along the arterial tree. Both systolic blood pressure and pulse pressure are higher in the periphery than in the central arteries for the same mean arterial pressure (MAP) and diastolic blood pressure. Whereas MAP refers exclusively to steady pressure, vascular resistance, and small arteries, systolic blood pressure and pulse pressure refer to pulsatile pressure and are determined by stroke volume, arterial stiffness, and wave reflection. Whereas a large rise in serum creatinine (≥100%) over baseline has been shown to portend a doubling of in-hospital mortality, it has also been shown that even the small relative increases in creatinine, used as a sensitive index of AKI after aortocoronary bypass graft (CABG)
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