Correlation between blood pressure variability and acute kidney disease in patients after heart surgery

Jiang Mengqiu; Hong Liang; Shen Xiao; Xue Yinying; Zhang Cui

doi:10.3969/j.issn.1674-4055.2025.03.08

Abstract：Objective To study the correlation between blood pressure variability(BPV)and acute kidney disease(AKD)in patients after heart surgery.Methods The clinical data were retrospectively analyzed in patients with acute kidney injury(AKI)in intensive care unit(ICU)after heart surgery in the First Hospital of Nanjing City from June 8,2019 to Dec.19,2022.Based on invasive blood pressure value from electronic database,BPV was calculated within the first 24 h of ICU admission after heart surgery.The correlation between postoperative BPV and AKD occurrence was reviewed by using single-factor and multi-factor Cox regression analysis.Results A total of 447 patients who developed AKI after cardiac surgery were included.Among them,109 patients(24%)progressed to AKD following AKI,while the remaining 338 patients did not develop AKD.The results of single-factor Cox analysis showed that postoperative BPV,diabetes history,history of atrial fibrillation(AF),type of surgery,level of cystatin C(Cys C),vasoactive drug scores,duration of ventilator use,and AKI grade were all significant influence factors for AKD occurrence.The multi-factor Cox regression model showed that,after adjusting for confounding factors,postoperative BPV was an independent risk factor for AKD(adjusted HR=1.13,95%CI:1.00～1.27,P=0.047).This result remained stable across multiple models and subgroup analyses.Conclusion The postoperative BPV plays a critical role in the deterioration of renal function in patients after heart surgery and serves as an independent risk factor for the development of AKD.This study not only provides a scientific basis for early hemodynamic management in patients after heart surgery,but also offers reliable predictive markers for early identifying high AKD risk.