Fine-Mapping the Association of Acute Kidney Injury With Mean Arterial and Central Venous Pressures During Coronary Artery Bypass Surgery

作者：Lee A. Goeddel, Marina Hernandez, Lily Koffman, Zachary Murphy, Ashish Khanna, Michael P. Robich, Glenn Whitman, Xinkai Zhou, Karen Bandeen‐Roche, John Muschelli, Chirag R. Parikh, João A.C. Lima, Ciprian M. Crainiceanu, Charles H. Brown, Nauder Faraday · 发表于：Anesthesia & Analgesia · 年份：2025 · DOI：10.1213/ane.0000000000007500 · 被引用次数：7 · 研究领域：Acute Kidney Injury Research、Hemodynamic Monitoring and Therapy、Cardiac, Anesthesia and Surgical Outcomes

BACKGROUND: Prior studies identified thresholds for mean arterial pressure (MAP <65 mm Hg) and central venous pressure (CVP >12 mm Hg) beyond which risk for cardiac surgery-associated acute kidney injury (AKI) increases. Optimal hemodynamic targets-that is, where active protection from AKI is observed-are unclear; however, current guidelines suggest maintaining MAP >65 and CVP 8 to 12. The aim of this study was to identify hemodynamic ranges associated with both increased and decreased risk of AKI by evaluating narrow ranges of MAP, CVP, and joint exposure to MAP and CVP concurrently. METHODS: In a retrospective cohort study of adults undergoing coronary artery bypass surgery, we fine-mapped the association between AKI and the total number of minutes spent in each of the following narrow hemodynamic ranges: 14 MAP ranges in increments of 5 mm Hg (45-115), 10 CVP ranges in increments of 2 mm Hg (0-20), and 70 joint MAP/CVP ranges. Separate multivariable regression models estimated adjusted odds ratios (aOR) for each range including adjustments for correlations and multiple comparisons across ranges. Joint MAP/CVP ranges were grouped into 5 hemodynamic zones based on contiguity of the ranges and similarity of ORs observed across ranges in a color-coded heatmap. The 5 MAP/CVP zones were included in a single regression model to assess risk for AKI associated with time spent in each hemodynamic zone, independent of time spent in other zones. RESULTS: In 1199 participants, incidenc...