Individualized Blood Pressure Regulation and Acute Kidney Injury in Older Patients Having Major Abdominal Surgery: A Pilot Randomized Trial

Authors

• Zhaohua Pang
• Shuang Liang
• Nannan Zhou
• Xiaoyan Zhu
• Qulian Guo
• Daniel I Sessler
• Wangyuan Zou

Language

English

Publication Date

4-1-2025

Journal

International Journal of Surgery

DOI

10.1097/JS9.0000000000002289

PMID

39878550

PMCID

PMC12175809

Abstract

Background: Acute kidney injury (AKI) is a common postoperative complication, and hypotension may contribute. We therefore tested the primary hypothesis that individualized intraoperative blood pressure regulation reduces postoperative AKI in older surgical patients.

Methods: We enrolled patients ≥60 years old scheduled for elective major abdominal surgery with invasive arterial pressure monitoring. All had goal-directed fluid management based on stroke volume variation cardiac output, and administration of a starch. Participants were randomly assigned to: (1) individualized blood pressure management targeting a systolic blood pressure (SBP) within -20% and +10% if baseline SBP was ≥130 mmHg or diastolic blood pressure was ≥80 mmHg, or otherwise, to target SBP within ±10% of the baseline value; (2) maintenance of SBP ≥90 mmHg and MAP ≥65 mmHg. Metaraminol was used to achieve the blood pressure target. AKI incidence was assessed by Kidney Disease Improving Global Outcomes criteria during the initial 7 postoperative days.

Results: 192 patients were assigned to individualized ( n = 96) or routine ( n = 96) pressure management. 179 patients were included in the intention-to-treat analysis. Age averaged 68 ± 5 (SD) years and 64% were male. Randomization to the individualized management reduced the area under MAP < 65 mmHg (median difference: -37 [-47 to -25] mmHg-minute, P < 0.001]. The incidence of the AKI was 11% in patients assigned to individualized management vs. 16 % in those assigned to routine management: relative risk 0.72 (95% confidence interval, 0.34-1.54), P = 0.396. Patients assigned to individualized pressure management had more urine output, a shorter postoperative mechanical ventilation duration, and faster recovery of bowel function.

Conclusion: Individualized blood pressure management markedly reduced hypotension. As expected in a pilot trial, the 28% reduction in AKI was not statistically significant. However, the reduction was clinically meaningful and suggests that a full trial is warranted.

Keywords

Humans, Acute Kidney Injury, Male, Female, Aged, Pilot Projects, Abdomen, Postoperative Complications, Middle Aged, Blood Pressure, Hypotension, Monitoring, Intraoperative, acute kidney injury, anesthesia, individualized, intraoperative hypotension, major abdominal surgery, older patients

Published Open-Access

yes

Recommended Citation

Pang, Zhaohua; Liang, Shuang; Zhou, Nannan; et al., "Individualized Blood Pressure Regulation and Acute Kidney Injury in Older Patients Having Major Abdominal Surgery: A Pilot Randomized Trial" (2025). Faculty, Staff and Student Publications. 1527.
https://digitalcommons.library.tmc.edu/uthsph_docs/1527