A sub-study of the POISE-3 randomized trial examined effects of a perioperative hypotension-avoidance strategy versus a hypertension-avoidance strategy on the risk of acute kidney injury

In this pre-specified sub-study of the POISE-3 trial, we examined the effect of a perioperative hypotension-avoidance strategy versus a hypertension-avoidance strategy on the risk of postoperative acute kidney injury (AKI). Altogether, 7307 patients were included from 110 hospitals in 22 countries. Patients were 45 years and older, had or were at risk of atherosclerotic disease, took at least one antihypertensive medication, and were scheduled for noncardiac surgery. Hypotension-avoidance strategy: (i) target intraoperative mean arterial pressure (MAP) 80 mm Hg or over, (ii) on day of surgery and for two days after, hold renin-angiotensin-aldosterone system inhibitors and use other antihypertensives in stepwise fashion if systolic blood pressure (SBP) 130 mm Hg or more. Hypertension-avoidance strategy: (i) target intraoperative MAP 60 mm Hg or more, (ii) continue all antihypertensives before and after surgery. Primary outcome: postoperative AKI, an increase in serum creatinine concentration of either 26.5 μmol/L or more (0.3 mg/dL or more) within 48 hours of randomization or 50% or more within seven days of randomization. The hypotension-avoidance group (3654 patients) used fewer antihypertensive medications than the hypertension-avoidance group (3653 patients); specifically, 6% vs. 38% used an ACEI or ARB on the day of surgery, and 6% vs. 47% and 7% vs. 50% one and two days after surgery, respectively. Patients also spent about half as much intraoperative time with a MAP under 80 mm Hg (27 vs. 60 minutes, respectively), but had little difference in average BP before or after surgery. There was no significant difference in AKI risk (15.1% vs. 14.4%). Results were consistent with other definitions of AKI and in patients with preexisting chronic kidney disease. Thus, a hypotension-avoidance strategy targeting a MAP greater than 80 mm Hg in the operating room and discontinued blood pressure medication during the perioperative period did not confer a lower risk of AKI compared to a hypertension avoidance strategy. Clinical trial registration number: NCT03505723.

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Journal
Kidney International
Published
2024-10-27
DOI
https://doi.org/10.1016/j.kint.2024.10.007
Citations
12
Primary Topic
Cardiac, Anesthesia and Surgical Outcomes
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article
Field-Weighted Citation Impact
4.82
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article

A sub-study of the POISE-3 randomized trial examined effects of a perioperative hypotension-avoidance strategy versus a hypertension-avoidance strategy on the risk of acute kidney injury

Michael Ke Wang, М. Yu. Кirov, Ameen Patel, Sabry S. Ayad et al.
12 citations
Kidney International
Cardiac, Anesthesia and Surgical Outcomes
4.82
article

A sub-study of the POISE-3 randomized trial examined effects of a perioperative hypotension-avoidance strategy versus a hypertension-avoidance strategy on the risk of acute kidney injury

Michael Ke Wang, М. Yu. Кirov, Ameen Patel, Sabry S. Ayad, Amit X. Garg, Mária Wittmann, В. Н. Ломиворотов, Héctor J. Hernández, Toby Richards, Kate Leslie, Chew Yin Wang, Emilie P. Belley‐Côté, Flávia K. Borges, Ingrid Copland, Jessica Vincent, Giovanni Landoni, Richard Paul Whitlock, Thomas Van Helder, Matthew T.V. Chan, Jessica Spence, Joel L. Parlow, Christian Sylvest Meyhoff, Chirag R. Parikh, Wojciech Szczeklik, Michael McGillion, P.J. Devereaux, Keyur Bhatt, Kurt Ruetzler, Timothy G. Short, Daniel I. Sessler, Carísi Anne Polanczyk, Ydo V. Kleinlugtenbelt, Mohammed Amir, Meaghan S. Cuerden, Samandar Ismoilov, William Ka Kei Wu, Denis Xavier, Denis Schmartz, William F. McIntyre, Chao Chia Cheong, Sergey Mihailovich Efremov, Pilar Paniagua, David Torres, Peter L. Gross, Pavel S Roshanov, Bruce Biccard, Andrea Kurz, David Conen, Sandra Ofori, Sergey V. Astrakov, Jessica M. Sontrop, María José Martínez‐Zapata, Thomas Painter, Edith Fleischmann, Valery V. Likhvantsev, Raja Jayaram, Maura Marcucci, John W. Eikelboom, Andre L. Lamy, Kumar Balasubramanian, Vikas Tandon, Miriam de Nadal, Sadeesh Srinathan, Emmanuelle Duceppe
article en
12 citations

Abstract

In this pre-specified sub-study of the POISE-3 trial, we examined the effect of a perioperative hypotension-avoidance strategy versus a hypertension-avoidance strategy on the risk of postoperative acute kidney injury (AKI). Altogether, 7307 patients were included from 110 hospitals in 22 countries. Patients were 45 years and older, had or were at risk of atherosclerotic disease, took at least one antihypertensive medication, and were scheduled for noncardiac surgery. Hypotension-avoidance strategy: (i) target intraoperative mean arterial pressure (MAP) 80 mm Hg or over, (ii) on day of surgery and for two days after, hold renin-angiotensin-aldosterone system inhibitors and use other antihypertensives in stepwise fashion if systolic blood pressure (SBP) 130 mm Hg or more. Hypertension-avoidance strategy: (i) target intraoperative MAP 60 mm Hg or more, (ii) continue all antihypertensives before and after surgery. Primary outcome: postoperative AKI, an increase in serum creatinine concentration of either 26.5 μmol/L or more (0.3 mg/dL or more) within 48 hours of randomization or 50% or more within seven days of randomization. The hypotension-avoidance group (3654 patients) used fewer antihypertensive medications than the hypertension-avoidance group (3653 patients); specifically, 6% vs. 38% used an ACEI or ARB on the day of surgery, and 6% vs. 47% and 7% vs. 50% one and two days after surgery, respectively. Patients also spent about half as much intraoperative time with a MAP under 80 mm Hg (27 vs. 60 minutes, respectively), but had little difference in average BP before or after surgery. There was no significant difference in AKI risk (15.1% vs. 14.4%). Results were consistent with other definitions of AKI and in patients with preexisting chronic kidney disease. Thus, a hypotension-avoidance strategy targeting a MAP greater than 80 mm Hg in the operating room and discontinued blood pressure medication during the perioperative period did not confer a lower risk of AKI compared to a hypertension avoidance strategy. Clinical trial registration number: NCT03505723.

Kidney InternationalVol. 107(1)
Veer Narmad South Gujarat University (IN), Universitat Autònoma de Barcelona (ES), Western University (CA), Jagiellonian University (PL), Universidade Federal do Rio Grande do Sul (BR), Lawson Health Research Institute (CA), Université Libre de Bruxelles (BE), University Health Network (CA), Johns Hopkins University (US), Vita-Salute San Raffaele University (IT), University of East London (GB), Outcomes Research Consortium (US), The University of Melbourne (AU), St Petersburg University (RU), Chinese University of Hong Kong (HK), Novosibirsk State University (RU), Universidad de Los Andes, Chile (CL), Queen's University (CA), University Hospital Bonn (DE), Johns Hopkins Medicine (US), London Health Sciences Centre (CA), Frederiksberg Hospital (DK), Auckland City Hospital (NZ), Hospital de Sant Pau (ES), Groote Schuur Hospital (ZA), Copenhagen University Hospital (DK), Population Health Research Institute (CA), University of Malaya (MY), Hospital Moinhos de Vento (BR), Centre Hospitalier Universitaire Brugmann (BE), City Hospital No. 40 (RU), Shifa Tameer-e-Millat University (PK), V.A. Negovsky Scientific Research Institute of General Reanimatology (RU), Centre Hospitalier de l’Université de Montréal (CA), St.John's Medical College Hospital (IN), Oxford University Hospitals NHS Trust (GB), Iberoamerican Cochrane Centre (ES), Meshalkin National Medical Research Center (RU), Deventer Ziekenhuis (NL), Kingston Health Sciences Centre (CA), Hospital Clínico Universitario de Valladolid (ES), The University of Texas Health Science Center (US), Northern State Medical University (RU), University of Manitoba (CA), The University of Adelaide (AU), Medical University of Vienna (AT), Hamilton Health Sciences (CA), McMaster University (CA)
Openalex Percentile: Top 4%
Cardiac, Anesthesia and Surgical Outcomes
4.82
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