Table 5. Acute kidney injury and other renal outcomes associated with perioperative hypotension.
| Author | Year | Sample size | Definition of hypotension | Results* | P-value | Injury |
|---|---|---|---|---|---|---|
| Hori et al.# [27] | 2016a | 110 | AUC <optimal BP (MAP with the lowest CFx) | 1.03 (1.01–1.05) | 0.017 | AKI |
| Ngu et al.# [49] | 2020 | 6,523 | MAP (mmHg) per 10 min post cardiopulmonary bypass, <55 mmHg | 1.13 (1.05–1.23) | 0.002 | De novo renal replacement therapy |
| MAP (mmHg) per 10 min post cardiopulmonary bypass, 55–64 mmHg | 1.12 (1.06–1.18) | 0.0001 | De novo renal replacement therapy | |||
| MAP (mmHg) per 10 min post cardiopulmonary bypass, <65 mmHg | 1.01 (0.96–1.07) | 0.651 | De novo renal replacement therapy | |||
| Ahuja et al. [13] | 2020 | 164,514 | AUC under SBP <90 mmHg, Q1 1–21 mmHg x min | 0.99 (0.80–1.24) | 0.991 | AKI |
| AUC under SBP <90 mmHg, Q2 22–66 mmHg x min | 1.14 (0.92–1.41) | 0.15 | AKI | |||
| AUC under SBP <90 mmHg, Q3 67–166 mmHg x min | 1.09 (0.87–1.35) | 0.345 | AKI | |||
| AUC under SBP <90 mmHg, Q4 >166 mmHg x min | 1.41 (1.14–1.75) | >0.001 | AKI | |||
| AUC under MAP <65 mmHg, Q1 1–25 mmHg x min | 1.07 (0.84–1.36) | 0.474 | AKI | |||
| AUC under MAP <65 mmHg, Q2 26–78 mmHg x min | 1.19 (0.94–1.50) | 0.069 | AKI | |||
| AUC under MAP <65 mmHg, Q3 79–198 mmHg x min | 1.06 (0.83–1.35) | 0.562 | AKI | |||
| AUC under MAP <65 mmHg, Q4 >198 mmHg x min | 1.43 (1.12–1.82) | <0.001 | AKI | |||
| AUC under DBP <50 mmHg, Q1 1–28 mmHg x min | 1.07 (0.84–1.36) | 0.477 | AKI | |||
| AUC under DBP <50 mmHg, Q2 29–99 mmHg x min | 1.07 (0.84–1.36) | 0.51 | AKI | |||
| AUC under DBP <50 mmHg, Q3 100–289 mmHg x min | 1.07 (0.83–1.35) | 0.562 | AKI | |||
| AUC under DBP <50 mmHg, Q4 >289 mmHg x min | 1.14 (0.89–1.47) | 0.191 | AKI | |||
| Gregory et al. [23] | 2020 | 368,222 | Absolute maximum decrease (for each 5 mmHg under IOH MAP thresholds) 75 mmHg | 1.10 (1.07–1.14) | Continuous renal replacement therapy/Dialysis | |
| Absolute maximum decrease (for each 5 mmHg under IOH MAP thresholds) 65 mmHg | 1.12 (1.07–1.17) | Continuous renal replacement therapy/Dialysis | ||||
| Absolute maximum decrease (for each 5 mmHg under IOH MAP thresholds) 55 mmHg | 1.12 (1.03–1.21) | Continuous renal replacement therapy/Dialysis | ||||
| Hallqvist et al. [25] | 2018 | 470 | The percentage decrease in SBP relative to baseline for more than 5 min (>40 to ≤50%) vs. ≤40% | 1.61 (0.99–2.62) | 0.054 | AKI |
| The percentage decrease in SBP relative to baseline for more than 5 min (>50%) vs. ≤40% | 2.27 (1.20–4.30) | 0.013 | AKI | |||
| The percentage decrease in SBP relative to baseline for more than 5 min (>40 to ≤50%) vs. ≤40% | 1.48 (0.90–2.44) | 0.11 | AKI | |||
| The percentage decrease in SBP relative to baseline for more than 5 min (>50%) vs. ≤40%b | 2.02 (1.05–3.89) | 0.034 | AKI | |||
| Jang et al.[30] | 2019 | 248 | SBP <80 mmHg or a mean BP <55–60 mmHg more than 5 min | 5.14 (1.54–20.35) | 0.012 | AKI |
| Liao et al. [38] | 2020 | 796 | Lowest absolute MAP <65 mmHg >10 min during surgery | 2.565 (1.271–5.177) | 0.009 | AKI |
| Mathis et al. [43] | 2020 | 138,021 | Absolute MAP 60–64 mmHg, low preoperative risk | 0.96 (0.73–1.27) | AKI | |
| Absolute MAP 60–64 mmHg, medium preoperative risk | 1.12 (0.93–1.36) | AKI | ||||
| Absolute MAP 60–64 mmHg, high preoperative risk | 1.18 (1.03–1.36) | <0.05 | AKI | |||
| Absolute MAP 60–64 mmHg, highest preoperative risk | 1.10 (0.99–1.22) | AKI | ||||
| Absolute MAP 55–59 mmHg, low preoperative risk | 0.90 (0.64–1.27) | AKI | ||||
| Absolute MAP 55–59 mmHg, medium preoperative risk | 1.18 (0.94–1.47) | AKI | ||||
| Absolute MAP 55–59 mmHg, high preoperative risk | 1.22 (1.04–1.43) | <0.05 | AKI | |||
| Absolute MAP 55–59 mmHg, highest preoperative risk | 1.39 (1.25–1.54) | <0.05 | AKI | |||
| Absolute MAP 50–54 mmHg, low preoperative risk | 1.44 (0.92–2.25) | AKI | ||||
| Absolute MAP 50–54 mmHg, medium preoperative risk | 1.23 (0.88–1.74) | AKI | ||||
| Absolute MAP 50–54 mmHg, high preoperative risk | 1.38 (1.08–1.76) | <0.05 | AKI | |||
| Absolute MAP 50–54 mmHg, highest preoperative risk | 1.57 (1.36–1.83) | <0.05 | AKI | |||
| Absolute MAP <50 mmHg, low preoperative risk | 1.32 (0.69–2.51) | AKI | ||||
| Absolute MAP <50 mmHg, medium preoperative risk | 1.77 (1.20–2.61) | <0.05 | AKI | |||
| Absolute MAP <50 mmHg, high preoperative risk | 1.64 (1.25–2.14) | <0.05 | AKI | |||
| Absolute MAP <50 mmHg, highest preoperative risk | 2.12 (1.79–2.50) | <0.05 | AKI | |||
| MAP 20–30% below baseline, low preoperative risk | 1.05 (0.79–1.39) | AKI | ||||
| MAP 20–30% below baseline, medium preoperative risk | 0.91 (0.74–1.11) | AKI | ||||
| MAP 20–30% below baseline, high preoperative risk | 0.93 (0.80–1.08) | AKI | ||||
| MAP 20–30% below baseline, highest preoperative risk | 0.86 (0.78–0.95) | AKI | ||||
| MAP 30–40% below baseline, low preoperative risk | 1.03 (0.77–1.38) | AKI | ||||
| MAP 30–40% below baseline, medium preoperative risk | 0.99 (0.81–1.21) | AKI | ||||
| MAP 30–40% below baseline, high preoperative risk | 1.03 (0.89–1.20) | AKI | ||||
| MAP 30–40% below baseline, highest preoperative risk | 0.91 (0.82–1.00) | AKI | ||||
| MAP >40% below baseline, low preoperative risk | 1.48 (1.09–2.00) | <0.05 | AKI | |||
| MAP >40% below baseline, medium preoperative risk | 1.40 (1.14–1.73) | <0.05 | AKI | |||
| MAP >40% below baseline, high preoperative risk | 1.24 (1.06–1.45) | <0.05 | AKI | |||
| MAP >40% below baseline, highest preoperative risk | 1.09 (0.98–1.22) | AKI | ||||
| Mizota et al. [46] | 2017 | 231 | Nadir MAP (per 10 mmHg decrease) | 2.11 (1.32–3.47) | 0.002 | AKI |
| Relative decrease in MAP (per 10% decrease) | 1.51 (1.11–2.09) | 0.01 | AKI | |||
| MAP 40–49 mmHg 1–9 min | 1.64 (0.49–5.43) | 0.419 | AKI | |||
| MAP 40–49 mmHg >10 min | 2.11 (0.61–7.22) | 0.236 | AKI | |||
| MAP <40 mmHg 1–9 min | 3.80 (1.17–12.30) | 0.026 | AKI | |||
| MAP <40 mmHg for >10 min | 5.06 (1.26–20.40) | 0.022 | AKI | |||
| Salmasi et al. [58] | 2017 | 57,315 | Time under MAP <65 mmHg 13–28 min | 1.20 (1.02–1.40) | 0.0049 | AKI |
| Time under MAP <65 mmHg >28 min | 1.35 (1.14–1.58) | <0.001 | AKI | |||
| Time in the lowest MAP categories, 50–55 mmHg 1 min | 1.25 (1.02–1.54) | 0.0061 | AKI | |||
| Time in the lowest MAP categories, 50–55 mmHg 2–4 min | 1.29 (1.04–1.61) | 0.0029 | AKI | |||
| Time in the lowest MAP categories, 50–55 mmHg >4 min | 1.43 (1.06–1.92) | 0.0031 | AKI | |||
| Time in the lowest MAP categories, <50 mmHg 2–4 min | 1.23 (1.00–1.50) | 0.011 | AKI | |||
| Time in the lowest MAP categories, <50 mmHg >4 min | 1.43 (1.15–1.78) | <0.0001 | AKI | |||
| Sun et al. [62] | 2015 | 5,127 | MAP <55 mmHg 1–5 min | 1.35 (0.98–1.86) | AKI | |
| MAP <55 mmHg 6–10 min | 1.45(0.94–2.22) | AKI | ||||
| MAP <55 mmHg 11–20 min | 2.34 (1.35–4.05) | AKI | ||||
| MAP <55 mmHg >20 min | 3.53 (1.51–8.25) | AKI | ||||
| MAP <60 mmHg 1–5 min | 1.10 (0.70–1.74) | AKI | ||||
| MAP<60 mmHg 6–10 min | 1.08(0.65–1.78) | AKI | ||||
| MAP <60 mmHg 11–20 min | 1.84(1.11–3.06) | AKI | ||||
| MAP <60 mmHg >20 min | 1.70(0.93–3.10) | AKI | ||||
| MAP <65 mmHg 1–5 min | 1.28 (0.57–2.87) | AKI | ||||
| MAP <65 mmHg 6–10 min | 1.56(0.69–3.50) | AKI | ||||
| MAP <65 mmHg 11–20 min | 1.57(0.70–3.53) | AKI | ||||
| MAP <65 mmHg >20 min | 2.25(0.99–5.07) | AKI | ||||
| Tang et al. [63] | 2019 | 4,952 | MAP <55 mmHg 1–5 min | 1.01 (0.51–2) | AKI | |
| MAP 55–59 mmHg 1–5 min | 0.75 (0.35–1.62) | AKI | ||||
| MAP 60–64 mmHg 1–5 min | 0.53 (0.23–1.24) | AKI | ||||
| MAP <55 mmHg 6–10 min | 0.96 (0.31–2.96) | AKI | ||||
| MAP 55–59 mmHg 6–10 min | 1.14 (0.37–3.51) | AKI | ||||
| MAP 60–64 mmHg 6–10 min | 0.23 (0.06–0.92) | <0.05 | AKI | |||
| MAP <55 mmHg 11–20 min | 3.25 (1.04–10.14) | <0.05 | AKI | |||
| MAP 55–59 mmHg 11–20 min | 2.40 (0.85–6.75) | AKI | ||||
| MAP 60–64 mmHg 11–20 min | 0.40 (0.11–1.47) | AKI | ||||
| MAP <55 mmHg >20 min | 14.11 (5.02–39.69) | <0.001 | AKI | |||
| MAP 55–59 mmHg >20 min | 7.46 (3.14–17.72) | <0.001 | AKI | |||
| MAP 60–64 mmHg >20 min | 2.78 (1.18–6.51) | <0.05 | AKI | |||
| Walsh et al. [67] | 2013 | 33,330 | MAP <55 mmHg 1–5 min | 1.18 (1.06–1.31) | AKI | |
| MAP <55 mmHg 6–10 min | 1.19 (1.03–1.39 | AKI | ||||
| MAP <55 mmHg 11–20 min | 1.32 (1.11–1.56) | AKI | ||||
| MAP <55 mmHg >20 min | 1.51 (1.24–1.84) | AKI |
Abbreviations: AUC: area under the curve, AKI: acute kidney injury, CFx: correlation flow index, CI: confidence interval, DBP: diastolic blood pressure, IOH: intraoperative hypotension, MAP: mean arterial pressure, min: minutes, OR: odds ratio, Q: quartile, SBP: systolic blood pressure.
*OR (95%CI),
# These articles refer to cardiac surgery.