Kidney Res Clin Pract.  2019 Sep;38(3):356-364. 10.23876/j.krcp.19.030.

Optimal systolic blood pressure in noncritically ill patients with acute kidney injury: A retrospective cohort study

• Baek SH
• Chin HJ
• Na KY
• Chae DW
• Kim S

• KMID: 2457727
• DOI: http://doi.org/10.23876/j.krcp.19.030

Abstract

BACKGROUND
Few data showed the optimal blood pressure (BP) in noncritically ill patients with acute kidney injury (AKI) relative to mortality or severe AKI. We therefore sought to analyze the data that exist for the ideal target range for BP in noncritically ill patients with AKI.
METHODS
We performed a retrospective cohort study involving 1,612 hospitalized patients who were diagnosed with AKI using the Kidney Disease: Improving Global Outcomes definition based on serum creatinine measurements for a period of 1 year. The average systolic BP (SBP) was categorized into 10-mmHg increments (within 48 hours after the development of AKI). The primary outcome was a composite of severe AKI or 90-day mortality.
RESULTS
The composite outcome rate in patients was 18.7% (302/1,612). The relationship between BP and the composite outcome followed a U-shaped curve, with an increased event rate observed at both low and high BP values. The average SBP after AKI predicted the composite outcome after adjusting for baseline variables (reference SBP: 120-129 mmHg; < 100 mmHg: hazard ratio [HR] 1.84, P = 0.015; 100-109 mmHg: HR 1.56, P = 0.038; 110-119 mmHg: HR 1.15, P = 0.483; 130-139 mmHg: HR 1.51, P = 0.045; ≥ 140 mmHg: HR 1.73, P = 0.005).
CONCLUSION
Among noncritically ill patients with AKI, a U-shaped curve association was observed between the average SBP within 48 hours after AKI and the composite primary outcome of this study, with the lowest event rate for SBP ranging from approximately 110 to 129 mmHg.

Keyword

Acute kidney injury; Mortality; Noncritically ill patient; Systolic blood pressure

MeSH Terms

Acute Kidney Injury*
Blood Pressure*
Cohort Studies*
Creatinine
Humans
Kidney Diseases
Mortality
Retrospective Studies*
Creatinine