Acute kidney injury in a 'well-filled patient': an unusual cause of elevated jugular venous pressure

Abstract Background We aimed to investigate the relationship between the perioperative hemodynamic parameters and the occurrence of cardiac surgery-associated acute kidney injury. Methods A retrospective study was performed in patients underwent cardiac surgery at a tertiary referral teaching hospital. Acute kidney injury was determined according to the KDIGO criteria. We investigated the association between the following perioperative hemodynamic parameters and cardiac surgery-associated acute kidney injury: mean arterial pressure, mean perfusion pressure, central venous pressure, and diastolic perfusion pressure. Multivariate regression analysis was conducted to identify the independent hemodynamic predictors for the development of acute kidney injury. Subgroup analysis was further performed in patients with chronic hypertension. Results Among 300 patients, 29.3% developed acute kidney injury during postoperative intensive care unit period. Multivariate logistic analysis showed the postoperative nadir diastolic perfusion pressure, but not mean arterial pressure, central venous pressure and mean perfusion pressure, was independently linked to the development of acute kidney injury after cardiac surgery (odds ratio 0.945, P = 0.045). Subgroup analyses in hypertensive subjects showed the postoperative nadir diastolic perfusion pressure and peak central venous pressure were both independently related to the development of acute kidney injury (nadir diastolic perfusion pressure, odds ratio 0.886, P = 0.033; peak central venous pressure, odds ratio 1.328, P = 0.010, respectively). Conclusions Postoperative nadir diastolic perfusion pressure was independently associated with the development of cardiac surgery-associated acute kidney injury. Furthermore, central venous pressure should be considered as a potential hemodynamic target for hypertensive patients undergoing cardiac surgery.

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Increase Renal Tubular Pressure to Treat Congestive Renal Failure

10.21203/rs.3.rs-1001793/v1 ◽

2021 ◽

Author(s):

xingxue pang ◽

Xiaowan Han ◽

Xian Wang

Keyword(s):

Acute Kidney Injury ◽

Renal Failure ◽

Treatment Strategy ◽

Urine Output ◽

Venous Pressure ◽

Kidney Injury ◽

Cardiorenal Syndrome ◽

Venous Hypertension ◽

Second Phase ◽

Renal Venous Hypertension

Abstract Background: Congestive renal failure commonly result from cardiorenal syndrome related renal venous hypertension(RVH)，which is more linked to the renal venous pressure than mean arterial pressure and systematic vascular resistance. But its mechanism and treatment strategy is still being explored.Methods: We did an investigator-initiated,open-label study to explore a novel treatment strategy and mechanism of renal venous hypertension related acute kidney injury(AKI).A patient with acute kidney injury(AKI) due to cardiorenal syndrome related renal venous hypertension was enrolled.The estimated pressure of renal vein (ePrv) was measured by ultrasound. Prior to the trial,residual urinary was detected by bedside ultrasound so as to rule out lower urinary tract obstruction.A three-lumen catheter was inserted into bladder for elevating tubular pressure and monitor intrabladder pressure.In the first phase,pressure of intrabladder was maintained equal to ePrv+8mmHg for 3 hours.In the second phase, intrabladder pressure was adjusted and maintained equal to ePrv for 21 hours. The urine volume is equal to the fluid expelled from bladder minus infused 0.9% Sodium chloride.Result: 130 milliliter urine output was secreted in the first phase and 370 milliliter in the second phase.A total of 500 milliliter urine output was secreted during the trial period (24 hours). 5 days after treatment, the patient's creatinine level dropped significantly.Conclusions: We first proposed a new therapeutic exploration, acute kidney injury secondary to cardiorenal syndrome related renal venous hypertension can be treated by increasing tubular pressure.Tubular compressed or even collapsed under renal venous hypertension may be an important mechanism of acute kidney injury due to RVH.

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GW26-e1347 High central venous pressure is associated with acute kidney injury and mortality in patients underwent cardiopulmonary bypass surgery

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2015.06.937 ◽

2015 ◽

Vol 66 (16) ◽

pp. C242

Author(s):

Yanli Yang ◽

Enming Qing ◽

Jun Ma

Keyword(s):

Acute Kidney Injury ◽

Cardiopulmonary Bypass ◽

Central Venous Pressure ◽

Bypass Surgery ◽

Venous Pressure ◽

Kidney Injury ◽

Central Venous ◽

Cardiopulmonary Bypass Surgery

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Assessment of Fluid Status by Bioimpedance Analysis and Central Venous Pressure Measurement and Their Association with the Outcomes of Severe Acute Kidney Injury

Medicina ◽

10.3390/medicina57060518 ◽

2021 ◽

Vol 57 (6) ◽

pp. 518

Author(s):

Justina Karpavičiūtė ◽

Inga Skarupskienė ◽

Vilma Balčiuvienė ◽

Rūta Vaičiūnienė ◽

Edita Žiginskienė ◽

...

Keyword(s):

Acute Kidney Injury ◽

Central Venous Pressure ◽

Venous Pressure ◽

Kidney Injury ◽

Adverse Outcomes ◽

Patient Treatment ◽

Bioimpedance Analysis ◽

Central Venous ◽

Fluid Status ◽

A Prospective Study

Background and Objectives: Fluid disbalance is associated with adverse outcomes in critically ill patients with acute kidney injury (AKI). In this study, we intended to assess fluid status using bioimpedance analysis (BIA) and central venous pressure (CVP) measurement and to evaluate the association between hyperhydration and hypervolemia with the outcomes of severe AKI. Materials and Methods: A prospective study was conducted in the Hospital of the Lithuanian University of Health Sciences Kauno Klinikos. Forty-seven patients treated at the Intensive Care Unit (ICU) with severe AKI and a need for renal replacement therapy (RRT) were examined. The hydration level was evaluated according to the ratio of extracellular water to total body water (ECW/TBW) of bioimpedance analysis and volemia was measured according to CVP. All of the patients were tested before the first hemodialysis (HD) procedure. Hyperhydration was defined as ECW/TBW > 0.39 and hypervolemia as CVP > 12 cm H2O. Results: According to bioimpedance analysis, 72.3% (n = 34) of patients were hyperhydrated. According to CVP, only 51.1% (n = 24) of the patients were hypervolemic. Interestingly, 69.6% of hypovolemic/normovolemic patients were also hyperhydrated. Of all study patients, 57.4% (n = 27) died, in 29.8% (n = 14) the kidney function improved, and in 12.8% (n = 6) the demand for RRT remained after in-patient treatment. A tendency of higher mortality in hyperhydrated patients was observed, but no association between hypervolemia and outcomes of severe AKI was established. Conclusions: Three-fourths of the patients with severe AKI were hyperhydrated based on bioimpedance analysis. However, according to CVP, only half of these patients were hypervolemic. A tendency of higher mortality in hyperhydrated patients was observed.

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The impact of relative hypotension on acute kidney injury progression after cardiac surgery: a multicenter retrospective cohort study

Annals of Intensive Care ◽

10.1186/s13613-021-00969-4 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Yuki Kotani ◽

Takuo Yoshida ◽

Junji Kumasawa ◽

Jun Kamei ◽

Akihisa Taguchi ◽

...

Keyword(s):

Acute Kidney Injury ◽

Cardiac Surgery ◽

Venous Pressure ◽

Weighted Average ◽

Kidney Injury ◽

Blood Pressure Target ◽

Hemodynamic Parameters ◽

Percentage Difference ◽

Time Weighted Average ◽

The Impact

Abstract Background Cardiac surgery is performed worldwide, and acute kidney injury (AKI) following cardiac surgery is a risk factor for mortality. However, the optimal blood pressure target to prevent AKI after cardiac surgery remains unclear. We aimed to investigate whether relative hypotension and other hemodynamic parameters after cardiac surgery are associated with subsequent AKI progression. Methods We retrospectively enrolled adult patients admitted to 14 intensive care units after elective cardiac surgery between January and December 2018. We defined mean perfusion pressure (MPP) as the difference between mean arterial pressure (MAP) and central venous pressure (CVP). The main exposure variables were time-weighted-average MPP-deficit (i.e., the percentage difference between preoperative and postoperative MPP) and time spent with MPP-deficit > 20% within the first 24 h. We defined other pressure-related hemodynamic parameters during the initial 24 h as exploratory exposure variables. The primary outcome was AKI progression, defined as one or more AKI stages using Kidney Disease: Improving Global Outcomes’ creatinine and urine output criteria between 24 and 72 h. We used multivariable logistic regression analyses to assess the association between the exposure variables and AKI progression. Results Among the 746 patients enrolled, the median time-weighted-average MPP-deficit was 20% [interquartile range (IQR): 10–27%], and the median duration with MPP-deficit > 20% was 12 h (IQR: 3–20 h). One-hundred-and-twenty patients (16.1%) experienced AKI progression. In the multivariable analyses, time-weighted-average MPP-deficit or time spent with MPP-deficit > 20% was not associated with AKI progression [odds ratio (OR): 1.01, 95% confidence interval (95% CI): 0.99–1.03]. Likewise, time spent with MPP-deficit > 20% was not associated with AKI progression (OR: 1.01, 95% CI 0.99–1.04). Among exploratory exposure variables, time-weighted-average CVP, time-weighted-average MPP, and time spent with MPP < 60 mmHg were associated with AKI progression (OR: 1.12, 95% CI 1.05–1.20; OR: 0.97, 95% CI 0.94–0.99; OR: 1.03, 95% CI 1.00–1.06, respectively). Conclusions Although higher CVP and lower MPP were associated with AKI progression, relative hypotension was not associated with AKI progression in patients after cardiac surgery. However, these findings were based on exploratory investigation, and further studies for validating them are required. Trial Registration UMIN-CTR, https://www.umin.ac.jp/ctr/index-j.htm, UMIN000037074.

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