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Higher Mean Arterial Pressure during Cardiopulmonary Bypass May Not Prevent Acute Kidney Injury in Elderly Patients

Yunfen Ge1, Tapas Ranjan Behera2, Ming Yu3

  • 1Center for Rehabilitation Medicine, Department of Anesthesiology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang 310014, China.

International Journal of Clinical Practice
|June 10, 2022
PubMed

Insights

Maintaining higher mean arterial pressure (MAP) during cardiopulmonary bypass (CPB) did not significantly prevent acute kidney injury (AKI) in elderly patients. Male sex was linked to a higher incidence of AKI post-cardiac surgery.

Area of Science:

  • Nephrology
  • Cardiology
  • Anesthesiology

Background:

  • Acute kidney injury (AKI) is a significant complication following cardiac surgery involving cardiopulmonary bypass (CPB).
  • The optimal mean arterial pressure (MAP) during CPB to mitigate AKI risk in elderly patients remains unclear.

Purpose of the Study:

  • To investigate the association between higher MAP during CPB and the incidence of AKI in elderly patients undergoing cardiac valve surgery.
  • To determine if maintaining MAP above 65 mmHg during CPB reduces AKI development.

Main Methods:

  • A cohort of elderly patients (>60 years) undergoing CPB was evaluated.
  • Patients were stratified into low MAP (<65 mmHg) and high MAP (>65 mmHg) groups during CPB.
  • AKI was diagnosed using the KDIGO criteria.

Main Results:

  • A higher incidence of AKI was observed in the high MAP group (40.48%) compared to the low MAP group (26%), though not statistically significant (p=0.140).
  • Mean MAP was significantly different between groups (61.14±5.54 mmHg vs. 68.97±3.65 mmHg, p<0.001).
  • Male sex was identified as a significant risk factor for developing AKI (p=0.034).

Conclusions:

  • A higher MAP (65-75 mmHg) during CPB did not demonstrate a significant protective effect against AKI in elderly patients undergoing cardiac valve surgery.
  • Further research is needed to establish optimal hemodynamic targets during CPB for AKI prevention in this population.

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