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ePublished: 01 Sep 2015
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J Renal Inj Prev. 2015;4(3): 61-67.
doi: 10.12861/jrip.2015.13
PMID: 26468476
PMCID: PMC4594215
  Abstract View: 3512
  PDF Download: 1792

Review Article

Intraoperative hypotension - a neglected causative factor in hospital-acquired acute kidney injury; a Mayo Clinic Health System experience revisited

Macaulay Amechi Chukwukadibia Onuigbo 1,2*, Nneoma Agbasi 3

1 Mayo Clinic College of Medicine, Rochester, MN 55905, USA
2 Department of Nephrology, Mayo Clinic Health System, Eau Claire, USA
3 North East London NHS Foundation Trust, UK
*Corresponding Author: *Corresponding author: Macaulay Amechi Chukwukadibia Onuigbo, Department of Nephrology, MCHS Eau Claire, 1221 Whipple Street, Eau Claire, WI 54702, USA. , Email: onuigbo.macaulay@mayo.edu

Abstract

Acute kidney injury (AKI) is a relatively common complication of cardiothoracic surgery and has both short- and long-term survival implications, even when AKI does not progress to severe renal failure. Given that currently, there are no active effective treatments for AKI, other than renal replacement therapy when indicated, the focus of clinicians ought to be on prevention and risk factor management. In the AKI-surgery literature, there exists this general consensus that intraoperative hypotension (IH) following hypotensive anesthesia (HA) or controlled hypotension (CH) in the operating room has no significant short-term and long-term impacts on renal function. In this review, we examine the basis for this consensus, exposing some of the flaws of the clinical study data upon which this prevailing consensus is based. We then describe our experiences in the last decade at the Mayo Clinic Health System, Eau Claire, in Northwestern Wisconsin, USA, with two selected case presentations to highlight the contribution of IH as a potent yet preventable cause of post-operative AKI. We further highlight the causative although neglected role of IH in precipitating postoperative AKI in chronic kidney disease (CKD) patients. We show additional risk factors associated with this syndrome and further make a strong case for the elimination of IH as an achievable mechanism to reduce overall, the incidence of hospital acquired AKI. We finally posit that as the old saying goes, prevention is indeed better than cure.

Implication for health policy/practice/research/medical education:

Acute kidney injury (AKI) is a relatively common complication of cardiothoracic surgery and has both short- and long-term survival implications, even when AKI does not progress to severe renal failure. Given that currently, there are no active effective treatments for AKI, other than renal replacement therapy when indicated, the focus of clinicians ought to be on prevention and risk factor management. In the AKI-surgery literature, there exists this general consensus that intraoperative hypotension (IH) following hypotensive anesthesia (HA) or controlled hypotension (CH) in the operating room has no significant short-term and long-term impacts on renal function.

Please cite this paper as: Onuigbo MAC, Agbasi N. Intraoperative hypotension - a neglected causative factor in hospital-acquired acute kidney injury; a Mayo Clinic Health System experience revisited. J Renal Inj Prev. 2015; 4(3): 61-67. DOI: 10.12861/jrip.2015.13

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