Perioperative Hypotension in Chronic Kidney Disease Patients with Dialysis Undergoing Noncardiac Surgery: A Retrospective Cohort Study.

Autor:	Tok Cekmecelioglu B; Outcomes Research Consortium, Houston, Texas; Department of Anesthesiology, Cleveland Clinic, Cleveland, Ohio., Tire Y; Outcomes Research Consortium, Houston, Texas; Department of Anesthesiology and Reanimation, Konya City Hospital, University of Health Science, Konya, Turkey., Sertcakacilar G; Outcomes Research Consortium, Houston, Texas; Department of Anesthesiology and Reanimation, Bakirkoy Sadi Konuk Research and Training Hospital, University of Health Science, Istanbul, Turkey., Ekrami E; Outcomes Research Consortium, Houston, Texas; Department of Anesthesiology, Cleveland Clinic, Cleveland, Ohio., Pu X; Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio., Kopac O; Outcomes Research Consortium, Houston, Texas; Department of Anesthesiology, Critical Care, and Pain Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas., Chu J; Outcomes Research Consortium, Houston, Texas., Roshanov PS; Department of Epidemiology and Biostatistics, and Department of Medicine, Division of Nephrology, Western University, London, Ontario, Canada; Population Health Research Institute, Hamilton, Ontario, Canada., Argalious M; Division of Multi-specialty Anesthesiology, Department of Anesthesiology, Integrated Hospital-Care Institute, Cleveland Clinic, Cleveland, Ohio., Ruetzler K; Outcomes Research Consortium, Houston, Texas; Department of Anesthesiology, Cleveland Clinic, Cleveland, Ohio., Turan A; Center of Outcomes Research and Department of Anesthesiology, Critical Care, and Pain Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas.
Jazyk:	angličtina
Zdroj:	Anesthesiology [Anesthesiology] 2025 Jan 01; Vol. 142 (1), pp. 132-141.
DOI:	10.1097/ALN.0000000000005253
Abstrakt:	Background: Patients with chronic kidney disease who require maintenance dialysis suffer excess morbidity and mortality for reasons that are not clearly elucidated. There are few targets for intervention to improve their outcomes. The authors hypothesized that perioperative hypotension is more common in patients receiving dialysis. Methodology: A retrospective cohort study was conducted of adult patients who had inpatient noncardiac surgery lasting greater than 2 h with general anesthesia between January 2012 and December 2021 at the Cleveland Clinic (Cleveland, Ohio). Using International Classification of Diseases codes and dialysis documentation in the electronic medical record, was derived age, American Society of Anesthesiologists (Schaumburg, Illinois) Physical Status, surgery type, and propensity score (predicting dialysis dependence) matched groups of patients (1) with dialysis-dependent chronic kidney disease, (2) with nondialysis chronic kidney disease, and (3) without kidney disease. The primary outcomes were total area under the curve of mean arterial pressure (MAP) less than 65 mmHg during the surgery and postoperative MAP less than 70 mmHg during 48 h after surgery. Results: Three 1:1:1 matched groups of 1,886 patients (total, 5,658 patients) from an overall cohort of 123,761 were derived. Cases with dialysis-dependent kidney disease had a greater intraoperative area under the curve of MAP less than 65 mmHg (difference in medians, 18.4 mmHg-min 98.75% CI, 11.3 to 25.6; P < 0.001) when compared to patients who had nondialysis kidney disease and when compared to patients without kidney disease (difference in medians, 15.5 mmHg-min; 98.75% CI, 6.6 to 24.4; P < 0.001). Patients receiving preoperative dialysis were also more likely to have postoperative MAP less than 70 mmHg compared to patients with nondialysis kidney disease (rate ratio, 1.52; 98.75% CI, 1.48 to 1.57; P < 0.0001) and compared to patients without kidney disease (rate ratio, 1.43; 98.75% CI, 1.38 to 1.47; P < 0.0001). Conclusions: Perioperative hypotension is more severe and common among patients who undergo chronic maintenance dialysis compared to similar patients without dialysis dependence. The management of hemodynamics in this population comes with unique considerations that warrant further systematic evaluation. (Copyright © 2024 American Society of Anesthesiologists. All Rights Reserved.)
Databáze:	MEDLINE
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