The Effect of Intraoperative Hypotension on Postoperative Renal Function

This review summarizes the most recent literature on the association between intraoperative hypotension (IOH) and the occurrence of postoperative acute kidney injury (AKI). It provides recommendations for the management of intraoperative blood pressure to reduce the incidence of postoperative AKI. Fluid management strategies, administration of vasopressor medications, and other methods for reducing the incidence of AKI are also briefly discussed.

Recent retrospective studies have demonstrated a solid association of IOH with postoperative AKI. IOH is associated not only with AKI but also with myocardial infarction, stroke, and death. Strict BP management to avoid a mean blood pressure less than 65mmHg is now recommended to reduce the incidence of postoperative AKI and other adverse outcomes.

IOH is robustly associated with AKI, and intraoperative mean BP should be maintained above 65 mmHg at all times. The etiology of postoperative AKI is however multifactorial, and factors other than BP therefore also need to be considered to prevent it.