Title:The Ignored Role of Intraoperative Hypotension in Producing Postoperative Acute Kidney Injury-An Obligatory Appeal for More Preventative Nephrology
Volume: 13
Issue: 1
Author(s): Macaulay Amechi Chukwukadibia Onuigbo*Nneoma Agbasi
Affiliation:
- Department of Nephrology, Mayo Clinic Health System, 1221 Whipple Street, Eau Claire, WI 54702,United States
Keywords:
Acute kidney injury, chronic kidney disease, end stage renal disease (ESRD), general anesthesia, hemodialysis,
intraoperative hypotension, preventative nephrology.
Abstract: Background/Objective: Intraoperative hypotension (IOH) invariably follows the
induction of general anesthesia during surgical operations. The current prevailing and predominant
consensus is that IOH has immense clinical benefits such as reduced bleeding, less need for blood
transfusions, and shorter surgery times. Simultaneously, it is assumed that IOH is devoid of adverse
renal, hepatic and neurological consequences. Emerging new evidence and our experiences suggest a
strong link between IOH and postoperative acute kidney injury (AKI).
Method/Case Reports: We report on three case presentations to illustrate the impact of IOH on
postoperative AKI.
Conclusion: Our recent experiences suggest and show a link between IOH and postoperative AKI.
Sun et al. (2015) recently demonstrated that postoperative AKI was associated with sustained intraoperative
hypotensive periods of MAP <55 and <60 mm Hg, respectively, in a graded pattern. Our
experiences and new emerging Surgery-AKI literature provide an impetus for clinical trials to be set
up and completed to determine whether interventions that promptly treat IOH, or better still that
prevent IOH, and that are tailored to suit individual patient physiology, would reduce the risk of
AKI. We posit that IOH is a neglected cause of postoperative AKI. We call for a preventative
nephrology paradigm shift and the targeting of MAP ≥ 60 mm Hg and/or SBP ≥ 90 mm Hg during
surgical procedures. Particularly in sub-Saharan Africa with its paucity of renal replacement therapy
options to manage kidney failure, every effort to limit AKI, SORO-ESRD and exacerbation of
kidney dysfunction in general, must be vigorously applied.
