Vasopressin and Major Adverse Kidney Events in Patients Requiring Vasopressor Support After Cardiac Surgery: A...

To examine whether early vasopressin use was associated with major adverse kidney events in patients requiring vasopressor support after cardiac surgery.

A multicenter retrospective cohort study using inverse probability of treatment weighting with overlap weights.

Four intensive care units in Queensland, Australia (2015-2021).

A total of 3,753 adults admitted after cardiac surgery (coronary artery bypass grafting, valve surgery, or combined procedures) requiring 6 or more consecutive hours of vasopressor support within the first 24 hours. Patients receiving extracorporeal membrane oxygenation were excluded.

Vasopressin use within 24 hours of intensive care unit admission versus no vasopressin.

The primary outcome was major adverse kidney events at 30 days, a composite of death, new renal replacement therapy, or creatinine doubling. Of 3,753 patients, 603 (16.1%) received vasopressin. After weighting, vasopressin was not associated with major adverse kidney events at 30 days (odds ratio [OR] 1.02, 95% confidence interval [CI] 0.76-1.38, p = 0.88). No differences were observed for 30-day mortality (OR 1.12, 95% CI 0.69-1.82), acute kidney injury within 7 days (OR 1.04, 95% CI 0.85-1.28), or new renal replacement therapy (OR 1.19, 95% CI 0.80-1.76). A significant interaction was observed for illness severity (p = 0.004), with a trend toward benefit in the highest-severity tertile.

Adjunctive vasopressin use was not associated with major adverse kidney events or mortality in patients requiring vasopressors after cardiac surgery. Heterogeneity of treatment effect by illness severity warrants prospective evaluation.