Early-phase cumulative hypotension duration and severe-stage progression in oliguric acute kidney injury with and without sepsis: an observational study

Crit Care. 2016 Dec 19;20(1):405. doi: 10.1186/s13054-016-1564-2.


Background: Managing blood pressure in patients with acute kidney injury (AKI) could effectively prevent severe-stage progression. However, the effect of hypotension duration in the early phase of AKI remains poorly understood. This study investigated the association between early-phase cumulative duration of hypotension below threshold mean arterial pressure (MAP) and severe-stage progression of oliguric AKI in critically ill patients, and assessed the difference in association with presence of sepsis.

Methods: This was a single-center, observational study conducted in the ICU of a university hospital in Japan. We examined data from adults with oliguric AKI who were admitted to the ICU during 2010-2014 and stayed in the ICU for ≥24 h after diagnosis of stage-1 oliguric AKI defined in the Kidney Disease Improving Global Outcomes (KDIGO) guidelines. The primary outcome was the progression from stage-1 oliguric AKI to stage-3 oliguric AKI (progression to oligoanuria and use of renal replacement therapy) according to the KDIGO criteria. During the first 6 h after oliguric AKI, we analyzed the association between cumulative time the patient had below threshold MAP (65, 70, and 75 mm Hg) and progression to stage-3.

Results: Among 538 patients with oliguric AKI, progression to stage-3 increased as the time spent below any threshold MAP was elongated. In the multivariable analysis of all patients, longer hypotension time (3-6 h) showed significant association with stage-3 progression for the time spent below MAP of 65 mm Hg (adjusted odds ratio (OR) 3.73, 95% confidence interval (CI) 1.53-9.09, p = 0.004), but the association was attenuated for the threshold MAP of 70 mm Hg (adjusted OR 2.35, 95% CI 0.96-5.78, p = 0.063) and 75 mm Hg (adjusted OR 1.92, 95% CI 0.72-5.15, p = 0.200). Longer hypotension time with the thresholds of 65 and 70 mm Hg was significantly associated with the risk of stage-3 progression in patients without sepsis, whereas the association was weak and not significant in patients with sepsis.

Conclusions: Even in a short time frame (6 h) after oliguric AKI diagnosis, early-phase cumulative hypotension duration was associated with progression to stage-3 oliguric AKI, especially in patients without sepsis.

Keywords: Acute kidney injury; Arterial pressure; Critical illness; Epidemiology; Hypotension; Intensive care unit.

Publication types

  • Observational Study

MeSH terms

  • Acute Kidney Injury / etiology*
  • Acute Kidney Injury / physiopathology
  • Aged
  • Arterial Pressure / physiology
  • Disease Progression*
  • Female
  • Humans
  • Hypotension / complications*
  • Intensive Care Units / organization & administration
  • Intensive Care Units / statistics & numerical data
  • Japan
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Oliguria / physiopathology
  • Patient Outcome Assessment
  • Sepsis / complications
  • Sepsis / physiopathology
  • Statistics, Nonparametric
  • Time Factors*
  • Water-Electrolyte Balance / physiology