Benefit of higher blood pressure target in severe acute kidney injury (AKI) treated by continuous renal replacement therapy (CRRT)
Ryo Matsuura, Yohei Komaru, Yoshifumi Hamasaki, Masaomi Nangaku, Kent Doi- Critical Care and Intensive Care Medicine
- Emergency Medicine
Abstract
Introduction
The optimal target of mean arterial pressure (MAP) during CRRT is unknown.
Method
We retrospectively collected the hourly MAP data in AKI patients requiring CRRT who admitted to the intensive care unit in the University of Tokyo hospital during 2011-2019. Patients who died within 48 hours of CRRT start and whose average value of hourly MAPs during the first 48 hours was <65 mmHg were excluded. When the average value of MAP was≤75 mmHg or > 75 mmHg, patients were allocated to the low or high target group. We estimated the effect of MAP on mortality and RRT independence at 90-day, using multivariable Cox regression model and Fine and Gray model.
Result
Of 275 patients we analyzed, 95 patients were in the low group. There are no differences in gender, baseline kidney function, disease severity. At 90 day, the low target group had higher mortality with 38 deaths (40.0%) compared with 57 deaths (31.7%) in the high target group (p < 0.05). The adjusted hazard ratio of the low target group (≤75 mmHg) for mortality was 1.72 (95%CI, 1.08-2.74). In addition, the low target group had lower rate of RRT independence, with 60 (63.2%) patients compared with 136 (75.6%) patients in the high target group (p < 0.05). The multivariable analysis revealed that adjusted hazard ratio of the low target group for RRT independence was 0.74 (95%CI, 0.54-1.01).
Conclusion
This study found the association with low MAP and mortality. The association with low MAP and delayed renal recovery was not revealed.