The association of postcardiac surgery acute kidney injury with intraoperative systolic blood pressure hypotension.

Abstract

Background. Postoperative acute kidney injury (AKI) is associated with high mortality and substantial cost after aortocoronary bypass graft (CABG) surgery. We tested the hypothesis that intraoperative systolic blood pressure variation is associated with postoperative AKI. Methods. We gathered demographic, procedural, blood pressure, and renal outcome data for 7,247 CABG surgeries at a single institution between 1996 and 2005. A development/validation cohort methodology was randomly divided (66% and 33%, resp.). Peak postoperative serum creatinine rise relative to baseline (%ΔCr) was the primary AKI outcome variable. Markers reflective of intraoperative systolic blood pressure variation were derived for each patient including (1) peak and nadir values (absolute and relative to baseline) and (2) excursion episodes beyond selected thresholds (by duration, frequency, and duration × degree). Each marker of systolic blood pressure variation was then separately evaluated for association with AKI using linear regression models with adjustment for several known risk factors (age, aprotinin use, congestive heart failure, previous myocardial infarction, baseline creatinine, bypass time, diabetes, weight, concomitant valve surgery, gender, and preoperative pulse pressure). Results. An association was identified between systolic blood pressure relative to baseline and postoperative AKI (P < 0.006). Conclusions. In CABG surgery patients, intraoperative systolic blood pressure decrease relative to baseline systolic blood pressure is independently associated with postoperative AKI.

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Citation

Published Version (Please cite this version)

10.1155/2013/174091

Publication Info

Aronson, Solomon, Barbara Phillips-Bute, Mark Stafford-Smith, Manuel Fontes, Jeffrey Gaca, Joseph P Mathew and Mark F Newman (2013). The association of postcardiac surgery acute kidney injury with intraoperative systolic blood pressure hypotension. Anesthesiol Res Pract, 2013. p. 174091. 10.1155/2013/174091 Retrieved from https://hdl.handle.net/10161/11133.

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Scholars@Duke

Aronson

Solomon Aronson

Professor Emeritus of Anesthesiology

Solomon Aronson, MD, MBA, FACC, FACCP, FAHA, FASE 

Solomon Aronson is a tenured professor at Duke University and Executive Vice Chairman in the Department of Anesthesiology.

Dr. Aronson earned his BS in molecular biology with distinction at the University of Wisconsin in Madison, and his MD with honors in research at the Medical College of Wisconsin in Milwaukee. After completing an anesthesiology residency including a year as chief resident at the University of Texas Medical Branch in Galveston, he completed a fellowship in cardiac and vascular anesthesia at the Texas Heart Institute in Houston.  Thereafter was recruited to the University of Chicago where he ascending to the rank of full professor and served as chief of the cardiothoracic and vascular anesthesia division for 12 years. In 2011, Dr. Aronson received his MBA with a concentration in Health Sector Management at Duke University Fuqua School of Business.

Having written over 300 manuscripts, book chapters, abstracts as well as 5 textbooks, he is recognized as an expert on topics concerning perioperative echocardiography, surgical anticoagulation and blood management, perioperative blood pressure risk, healthcare strategy and health economics as well as other related topics in cardiovascular anesthesia and cardiology, he has lectured nationally and internationally.  

Among the many research awards and lecture honors received over the years, Dr. Aronson has been repeatedly elected from among his peers to be listed in Best Doctors in America. Dr. Aronson continues to serve on the Joint Commission and AMA task force for overuse as well as the FDA as a consultant SGE after having served on the FDA as a member of the Anesthesia and Life support advisory committee and Anesthetic and Analgesic Drug Products Advisory Committee (AADPAC). He is an elected fellow of the American Heart Association, the American College of Chest Physicians, the American College of Cardiology, and the American Society of Echocardiography and an elective member of the Association of Cardiovascular Anesthesiologist and Association of University Anesthesiologists.  

Dr. Aronson is the director of strategic business development for the Physicians Diagnostic Clinic (PDC), a 1600 member physician practice group at Duke and has severed as chair of the Finance Committee for the PDC in the past. He currently serves on the PDC Board of managers.  He has served as a member of the economic committee of the American Society of Anesthesiologists for over 10 years and currently serves on the Future Models of Anesthesia Practice committee for the ASA.  In addition, he served on the board of directors and was president of the intraoperative council in the American Society of Echocardiography and he also served on the board of directors and was president for the Society of Cardiovascular Anesthesiology. He remains on the board of trustees for the Society of Cardiovascular Anesthesiology and the Society of Cardiovascular Anesthesiology Foundation. He is a founding trustee member of the National Board of Echocardiography and has served on their board of directors. In 2013, he was elected to serve on the Science Accelerator Committee and the Leadership Committee for Cardiopulmonary, Critical Care, Perioperative & Resuscitation Council of the American Heart Association.

Dr. Aronson is married to Dr. Leena Sharma and they have 2 children – twins- in college. In addition to enjoying time with his family, he works at his tennis and golf games, listens to music, pursues drawing and painting interests and enjoys traveling and serving his community. He currently serves on the board of directors for the Boys and Girls Club of America in Durham.

Stafford-Smith

Mark Stafford-Smith

Professor Emeritus of Anesthesiology

My research interests are in the area of Cardiothoracic Anesthesiology. The main focus of my research is towards the understanding and prevention of acute kidney injury after cardiac and other major surgeries. Secondary interests include the study of analgesic strategies after cardiothoracic surgical procedures, performance of clinical trials, and perioperative transfusion and hemostasis.

Gaca

Jeffrey Giles Gaca

Associate Professor of Surgery
Mathew

Joseph P. Mathew

Jerry Reves, M.D. Distinguished Professor of Cardiac Anesthesiology

Current research interests include:
1. The relationship between white matter patency, functional connectivity (fMRI) and neurocognitive function following cardiac surgery.
2. The relationship between global and regional cortical beta-amyloid deposition and postoperative cognitive decline.
3. The effect of lidocaine infusion upon neurocognitive function following cardiac surgery.
4. The association between genotype and outcome after cardiac surgery.
5. Atrial fibrillation following cardiopulmonary bypass.

Newman

Mark Franklin Newman

Merel H. Harmel Distinguished Professor Emeritus of Anesthesiology

Best known for his work in assessing and improving clinical outcomes and quality of life following cardiac surgery, Dr. Mark Newman is President of the Duke Private Diagnostic Clinic (The Duke Faculty Practice Organization) and the Merel H. Harmel Professor of Anesthesiology at Duke University Medical Center. In addition, Dr. Newman developed the Multicenter Perioperative Outcomes Research Group of the Duke Clinical Research Institute established at Duke in 2001 to further the study of strategies to improve the outcomes of patients undergoing surgery and anesthesia. Dr. Newman has received funding from the National Institute on Aging, the American Heart Association, the National Heart, Lung and Blood Institute, the Anesthesia Patient Safety Foundation, and the International Anesthesia Research Society  to investigate the impact of perioperative outcomes (neurocognitive decline, stroke, myocardial infarction, renal injury) on quantity and quality of life following cardiac surgery and resulting in numerous seminal publications in the New England Journal of Medicine, JAMA and Lancet. Dr. Newman is a popular lecturer and speaker, having appeared on NBC Nightly News and The Today Show and having spoken at more than 200 national and international meetings.  Dr. Newman recently stepped down as the Chairman of the Duke University Department after 13 years to assume the role of PDC President.  During Dr. Newman’s tenure the department grew exponentially doubling its clinical and academic funding, and developing many outstanding individuals that have gone on to leadership roles at Duke and other key academic institutions across the country.


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