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Research Article | Open Access

Intraoperative hypotension associated with postoperative acute kidney injury in hypertension patients undergoing non-cardiac surgery: a retrospective cohort study

Jin Li1,†, Yeshuo Ma2,†, Yang Li1,†, Wen Ouyang1, Zongdao Liu2, Xing Liu1, Bo Li3, Jie Xiao4, Daqing Ma5 , Yongzhong Tang1,6 ( )
Department of Anesthesiology, Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, 410013, China
Department of Geriatrics, Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, 410013, China
Operation Center, Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, 410013, China
Department of Emergency, Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, 410013, China
Division of Anesthetics, Pain Medicine & Intensive Care, Department of Surgery and Cancer, Chelsea and Westminster Hospital, Imperial College London, South Kensington Campus, London SW7 2AZ, UK
Clinical Research Center, Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, 410013, China

†Jin Li, Yeshuo Ma and Yang Li contributed equally to this work.

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Highlights

• We explored the appropriately perioperative management of intraoperative blood pressure to prevent against postoperative acute kidney injury (AKI) in the hypertensive patients undergoing a non-cardiac surgery.

• MAP less than 60 mmHg for more than 20 min was an independent risk factor of postoperative AKI, and for more than 10 min in the subgroup of invasive MAP.

• Our results provided the important evidences for the rational management of intraoperative MAP in the hypertensive patients. It also suggested that invasive measurement could reflect the true values of blood pressure more exactly.

Abstract

Background

Acute kidney injury (AKI) is a common surgical complication and is associated with intraoperative hypotension. However, the total duration and magnitude of intraoperative hypotension associated with AKI remains unknown. In this study, the causal relationship between the intraoperative arterial pressure and postoperative AKI was investigated among chronic hypertension patients undergoing non-cardiac surgery.

Methods

A retrospective cohort study of 6552 hypertension patients undergoing non-cardiac surgery (2011 to 2019) was conducted. The primary outcome was AKI as diagnosed with the Kidney Disease-Improving Global Outcomes criteria and the primary exposure was intraoperative hypotension. Patients’ baseline demographics, pre- and post-operative data were harvested and then analyzed with multivariable logistic regression to assess the exposure–outcome relationship.

Results

Among 6552 hypertension patients, 579 (8.84%) had postoperative AKI after non-cardiac surgery. The proportions of patients admitted to ICU (3.97 vs. 1.24%, p < 0.001) and experiencing all-cause death (2.76 vs. 0.80%, p < 0.001) were higher in the patients with postoperative AKI. Moreover, the patients with postoperative AKI had longer hospital stays (13.50 vs. 12.00 days, p < 0.001). Intraoperative mean arterial pressure (MAP) < 60 mmHg for >20 min was an independent risk factor of postoperative AKI. Furthermore, MAP <60 mmHg for >10 min was also an independent risk factor of postoperative AKI in patients whose MAP was measured invasively in the subgroup analysis.

Conclusions

Our work suggested that MAP < 60 mmHg for >10 min measured invasively or 20 min measured non-invasively during non-cardiac surgery may be the threshold of postoperative AKI development in hypertension patients. This work may serve as a perioperative management guide for chronic hypertension patients.

Trial registration

clinical trial number: ChiCTR2100050209 (8/22/2021).

http://www.chictr.org.cn/showproj.aspx?proj=132277.

Keywords

Acute kidney injuryIntraoperative hypotensionNon-cardiac surgeryChronic hypertension

References

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Burns & Trauma
Volume 12,
December 2024
Article number: tkae029
DOI: 10.1093/burnst/tkae029

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Cite this article:
Li J, Ma Y, Li Y, et al. Intraoperative hypotension associated with postoperative acute kidney injury in hypertension patients undergoing non-cardiac surgery: a retrospective cohort study. Burns & Trauma, 2024, 12: tkae029. https://doi.org/10.1093/burnst/tkae029

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Received: 25 July 2023
Revised: 01 December 2023
Accepted: 08 May 2024
Published: 10 October 2026
© The Author(s) 2024. Published by Oxford University Press.

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.