Vasopressin and Major Adverse Kidney Events in Patients Requiring Vasopressor Support After Cardiac Surgery: A Multicenter Retrospective Cohort Study

OBJECTIVES: To examine whether early vasopressin use was associated with major adverse kidney events in patients requiring vasopressor support after cardiac surgery. DESIGN: A multicenter retrospective cohort study using inverse probability of treatment weighting with overlap weights. SETTING: Four intensive care units in Queensland, Australia (2015-2021). PARTICIPANTS: A total of 3,753 adults admitted after cardiac surgery (coronary artery bypass grafting, valve surgery, or combined procedures) requiring 6 or more consecutive hours of vasopressor support within the first 24 hours. Patients receiving extracorporeal membrane oxygenation were excluded. INTERVENTIONS: Vasopressin use within 24 hours of intensive care unit admission versus no vasopressin. MEASUREMENTS AND MAIN RESULTS: The primary outcome was major adverse kidney events at 30 days, a composite of death, new renal replacement therapy, or creatinine doubling. Of 3,753 patients, 603 (16.1%) received vasopressin. After weighting, vasopressin was not associated with major adverse kidney events at 30 days (odds ratio [OR] 1.02, 95% confidence interval [CI] 0.76-1.38, p = 0.88). No differences were observed for 30-day mortality (OR 1.12, 95% CI 0.69-1.82), acute kidney injury within 7 days (OR 1.04, 95% CI 0.85-1.28), or new renal replacement therapy (OR 1.19, 95% CI 0.80-1.76). A significant interaction was observed for illness severity (p = 0.004), with a trend toward benefit in the highest-severity tertile. CONCLUSIONS: Adjunctive vasopressin use was not associated with major adverse kidney events or mortality in patients requiring vasopressors after cardiac surgery. Heterogeneity of treatment effect by illness severity warrants prospective evaluation.