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

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Author(s)
Yaerim KimDonghwan YunSoie KwonKyubok JinSeungyeup HanDong Ki KimKook-Hwan OhKwon Wook JooYon Su KimSejoong KimSeung Seok Han
Keimyung Author(s)
Kim, Yae RimJin, Kyu BokHan, Seung Yeup
Department
Dept. of Internal Medicine (내과학)
Journal Title
BMC Nephrol
Issued Date
2021
Volume
22
Keyword
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.
Keimyung Author(s)(Kor)
김예림
진규복
한승엽
Publisher
School of Medicine (의과대학)
Citation
Yaerim Kim et al. (2021). Target value of mean arterial pressure in patients undergoing continuous renal replacement therapy due to acute kidney injury. BMC Nephrol, 22, 20. doi: 10.1186/s12882-020-02227-4
Type
Article
ISSN
1471-2369
Source
https://bmcnephrol.biomedcentral.com/articles/10.1186/s12882-020-02227-4
DOI
10.1186/s12882-020-02227-4
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/43578
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Internal Medicine (내과학)
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