Newly Published
Editorial  |   January 2020
Preoperative Risk, Blood Pressure, and Acute Kidney Injury
Author Notes
  • From the Division of Cardiac Anesthesiology, University of Ottawa Heart Institute, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; and Cardiovascular Research Program, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
  • Accepted for publication December 3, 2019.
    Accepted for publication December 3, 2019.×
  • This editorial accompanies the article on p. XXX.
    This editorial accompanies the article on p. XXX.×
  • Correspondence: Address correspondence to Dr. Sun: lsun@ottawaheart.ca
Article Information
Editorial / Cardiovascular Anesthesia / Patient Safety / Renal and Urinary Systems / Electrolyte Balance
Editorial   |   January 2020
Preoperative Risk, Blood Pressure, and Acute Kidney Injury
Anesthesiology Newly Published on January 8, 2020. doi:https://doi.org/10.1097/ALN.0000000000003101
Anesthesiology Newly Published on January 8, 2020. doi:https://doi.org/10.1097/ALN.0000000000003101
Acute kidney injury (AKI) is a serious complication after surgery and an important area of perioperative investigation. Recent studies have pointed to the prevention and treatment of intraoperative hypotension as a potential mitigation strategy. However, the optimal blood pressure needed to maintain end organ perfusion under general anesthesia is unclear and may vary by surgery type and individual characteristics. Hypotension is most commonly defined as systolic blood pressure of less than 80 or 90 mmHg, mean arterial pressure (MAP) of less than 55, 60, and 65, or relative decreases in MAP at or above 20% or 25% from the baseline value.1  Single-center studies have shown that even brief periods of mild hypotension can be associated with AKI after major noncardiac, nonurologic surgery. A seminal paper by Walsh et al. concluded that there was no safe duration of MAP below 55 mmHg during noncardiac surgery.2  A subsequent study by our group reported that AKI was associated with MAP below 60 mmHg in a dose-dependent fashion.3  This was followed by a retrospective cohort study by Salmasi et al., who reported an absolute MAP threshold of less than 65 mmHg, and a relative threshold of more than 20% decrease from baseline, to be associated with AKI.4  The advent of personalized medicine calls for an approach to blood pressure management that tailors to the uniqueness of each individual undergoing surgery.