Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Mar:221:67-73.
doi: 10.1016/j.ahj.2019.12.013. Epub 2019 Dec 27.

Central venous pressure and the risk of diuretic-associated acute kidney injury in patients after cardiac surgery

Ian E McCoy  1 , Maria E Montez-Rath  2 , Glenn M Chertow  2 , Tara I Chang  2
Affiliations

Central venous pressure and the risk of diuretic-associated acute kidney injury in patients after cardiac surgery

Ian E McCoy et al. Am Heart J. 2020 Mar.

Abstract

Background: When prescribing diuretics in the postcardiac surgical intensive care unit (ICU), clinicians may use central venous pressure (CVP) to assess volume status and the risk of acute kidney injury (AKI). In this study, we examined how the risk of diuretic-associated AKI varied with CVP in patients undergoing cardiac surgery.

Methods: We used the Medical Information Mart for Intensive Care database to study adults admitted to the postcardiac surgical ICU at an urban, academic medical center between 2001 and 2012. We examined the odds of AKI per 1-mm Hg increase in CVP among patients receiving intravenous loop diuretics using multivariable adjusted logistic regression. We examined the risk of AKI among patients with diuretic use (vs nonuse) across tertiles of CVP using inverse probability treatment weighting.

Results: Among 4,164 patients receiving intravenous loop diuretics, the adjusted odds of subsequent AKI were 1.11 (95% CI 1.08-1.13) times higher per mm Hg increase in mean CVP. This association was log-linear across the entire range of CVPs observed. In the analysis of diuretic use (n = 5,396), the adjusted risk ratio for AKI with diuretic use (vs nonuse) was 1.33 (95% CI 1.21-1.47) and did not materially differ across tertile of CVP.

Conclusions: Higher rather than lower CVP is an independent marker of AKI risk. The risk of AKI associated with diuretic use may not be influenced by CVP. Novel methods of assessing volume status and AKI risk are needed to guide patient selection for diuretic therapy.

PubMed Disclaimer

Conflict of interest statement

Disclosures None.

Figures

Figure 1:
Figure 1:
Cohort assembly CVP, central venous pressure; ESRD, end-stage renal disease; ICU, intensive care unit
Figure 2:
Figure 2:
Incidence of subsequent AKI by mean CVP on ICU day 1 AKI, acute kidney injury; CVP, central venous pressure
Figure 3:
Figure 3:
Relationship between mean CVP on ICU day 1 and the log odds of subsequent AKI AKI, acute kidney injury; CVP, central venous pressure
Figure 4.
Figure 4.
Risk ratios of intravenous loop diuretic use (versus non-use) for subsequent AKI across CVP tertiles AKI, acute kidney injury; CVP, central venous pressure; RR, risk ratio
See this image and copyright information in PMC

Comment in

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Heart Failure Society of America. Section 12: Evaluation and Management of Patients with Acute Decompensated Heart Failure. J Card Fail 2010. June;16(6):e134–56. - PubMed
    1. Testani JM, Khera AV., John Sutton MG, Keane MG, Wiegers SE, Shannon RP, et al. Effect of Right Ventricular Function and Venous Congestion on Cardiorenal Interactions During the Treatment of Decompensated Heart Failure. Am J Cardiol 2010. February;105(4):511–6. - PMC - PubMed
    1. Mullens W, Abrahams Z, Francis GS, Sokos G, Taylor DO, Starling RC, et al. Importance of Venous Congestion for Worsening of Renal Function in Advanced Decompensated Heart Failure. J Am Coll Cardiol 2009. February;53(7):589–96. - PMC - PubMed
    1. Chen KP, Cavender S, Lee J, Feng M, Mark RG, Celi LA, et al. Peripheral edema, central venous pressure, and risk of AKI in critical illness. Clin J Am Soc Nephrol 2016;11(4):602–8. - PMC - PubMed
    1. Williams JB, Peterson ED, Wojdyla D, Harskamp R, Southerland KW, Ferguson TB, et al. Central venous pressure after coronary artery bypass surgery: Does it predict postoperative mortality or renal failure? J Crit Care 2014. December;29(6):1006–10. - PMC - PubMed

Publication types

Substances