Abstract: FR-OR107
Effect of a Perioperative Hypotension Avoidance Strategy vs. a Hypertension Avoidance Strategy on the Risk of AKI
Session Information
- Late-Breaking Science Orals - 1
October 25, 2024 | Location: Room 6C, Convention Center
Abstract Time: 04:40 PM - 04:50 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Garg, Amit X., Western University, London, Ontario, Canada
- Marcucci, Maura, McMaster University, Hamilton, Canada
- Cuerden, Meaghan S., London Health Sciences Centre, London, Ontario, Canada
- Sontrop, Jessica M., London Health Sciences Centre, London, Ontario, Canada
- Devereaux, PJ, McMaster University, Hamilton, Ontario, Canada
Group or Team Name
- Perioperative Ischemic Evaluation-3 (POISE-3) Investigators.
Background
Acute kidney injury (AKI) is a common complication of the over 200 million noncardiac surgeries performed worldwide each year. We conducted a pre-specified substudy of the POISE-3 trial to determine whether a peri-operative hypotension-avoidance strategy versus a hypertension-avoidance strategy alters the risk of postoperative AKI (substudy protocol publication: PMID 35024154).
Methods
This was a two-group, open-label, randomized trial of 7307 high-risk patients from 110 hospitals in 22 countries undergoing noncardiac surgery. Patients were ≥ 45 years old and took at least one antihypertensive medication.
hypotension-avoidance strategy
... target intraopertive mean arterial pressure (MAP) ≥80 mmHg
... on day of surgery and for 2 days after, aim to hold renin-angiotensin-aldosterone system inhibitors
... stepwise use other long-term antihypertensive medications if SBP ≥130 mmHg
hypertension-avoidance strategy
... target intraoperative MAP ≥60 mmHg
... continue all antihypertensive medications before and after surgery.
The primary outcome was postoperative AKI, defined as an increase in serum creatinine concentration of either ≥26.5 μmol/L (≥0.3 mg/dL) within 48 hours of randomization or ≥50% within 7 days of randomization.
Results
The hypotension-avoidance group (n=3654) vs. the hypertension-avoidance group (n=3653),
... used fewer antihypertensive medications
...........specifically, 6% vs. 38% of patients used an ACEi or ARB on the day of surgery,
..............................6% vs. 47% one day after surgery,
............................. 7% vs. 50% two days after surgery.
... spent less intraoperative time with a MAP < 80 mmHg (average 28% vs. 45% of the time)
... had no difference in mean SBP/DBP/MAP outside the operation (day of surgery and two days after surgery)
... had no difference in the risk of AKI
........... (15.1% vs. 14.4%; relative risk 1.05 [95% CI, 0.93 to 1.19]).
Results were consistent with multiple alternate continuous and categorical definitions of AKI and in the subgroup with baseline chronic kidney disease.
Conclusion
In this trial of patients undergoing noncardiac surgery, the risk of postoperative AKI did not differ between patients randomized to receive a hypotension-avoidance strategy versus a hypertension-avoidance strategy..
Trial registration: NCT03505723.
Funding
- Private Foundation Support