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Target value of mean arterial pressure in patients undergoing continuous renal replacement therapy due to acute kidney injury

Cited 2 time in Web of Science Cited 2 time in Scopus
Authors
Kim, Yaerim; Yun, Donghwan; Kwon, Soie; Jin, Kyubok; Han, Seungyeup; Kim, Dong Ki; Oh, Kook-Hwan; Joo, Kwon Wook; Kim, Yon Su; Kim, Sejoong; Han, Seung Seok
Issue Date
2021-01-09
Publisher
BMC
Citation
BMC Nephrology. 2021 Jan 09;22(1):20
Keywords
Acute kidney injuryContinuous renal replacement therapyMean arterial pressureMortality
Abstract
Background
Although patients undergoing continuous renal replacement therapy (CRRT) due to acute kidney injury (AKI) frequently have instability in mean arterial pressure (MAP), no consensus exists on the target value of MAP related to high mortality after CRRT.

Methods
A total of 2,292 patients who underwent CRRT due to AKI in three referral hospitals were retrospectively reviewed. The MAPs were divided into tertiles, and the 3rd tertile group served as a reference in the analyses. The major outcome was all-cause mortality during the intensive care unit period. The odds ratio (OR) of mortality was calculated using logistic regression after adjustment for multiple covariates. The nonlinear relationship regression model was applied to determine the threshold value of MAP related to increasing mortality.

Results
The mean value of MAP was 80.7 ± 17.3 mmHg at the time of CRRT initiation. The median intensive care unit stay was 5 days (interquartile range, 2–12 days), and during this time, 1,227 (55.5%) patients died. The 1st tertile group of MAP showed an elevated risk of mortality compared with the 3rd tertile group (adjusted OR, 1.28 [1.03–1.60]; P = 0.029). In the nonlinear regression analysis, the threshold value of MAP was calculated as 82.7 mmHg. Patients with MAP < 82.7 mmHg had a higher mortality rate than those with ≥ 82.7 mmHg (adjusted OR, 1.21 [1.01–1.45]; P = 0.037).

Conclusions
Low MAP at CRRT initiation is associated with a high risk of mortality, particularly when it is < 82.7 mmHg. This value may be used for risk classification and as a potential therapeutic target.
ISSN
1471-2369
Language
English
URI
https://hdl.handle.net/10371/173381
DOI
https://doi.org/10.1186/s12882-020-02227-4
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College of Medicine/School of Medicine (의과대학/대학원)Internal Medicine (내과학전공)Journal Papers (저널논문_내과학전공)
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