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논문분류	춘계학술대회 초록집
제목	What is the Optimal Blood Pressure in Patients with Acute Kidney Injury?
저자	Seon Ha Baek1, Ho Jun Chin2, Ki Yong Na2, Dong-Wan Chae2, Sejoong Kim2
출판정보	2018; 2018(1):
키워드	acute kidney injury \| systolic blood pressure \| severity \| mortality
초록	Objectives: Blood pressure (BP) is an important target for kidney injury, but few data showed optimal BP in patients with acute kidney injury (AKI) relative to severe AKI or mortality. Methods: We performed a retrospective cohort study of 1612 patients who had their creatinine levels measured (≥ 1 measurement) during admission for a period of 1 year (January 1, 2013 through December 31, 2013) at tertiary hospital and were diagnosed with AKI by Kidney Disease Improving Global Outcomes (KDIGO) definition based on serum creatinine criteria. We excluded patients with missing BP data, pre-existing end stage renal disease and intensive care unit admission during hospitalization. Average systolic BP was categorized into 10-mmHg increments (within 48 hours after development of AKI). The primary outcome was a composite of severe AKI or 90-day mortality. Results: The composite outcome rate for patients was 18.7 % (302/1612). The relationship between BP and composite outcome followed a U-shaped curve, with an increased event rate at both low and high BP values. Average SBP after AKI predicted for composite outcome after adjustment for baseline variables (reference SBP ≥ 140mmHg, <100mmHg, hazard ratio [HR] 0.925, P = 0.761; 100-110mmHg, HR 0.863, P = 0.484; 110-120mmHg, HR 0.624, P = 0.017; 120-130mmHg, HR 0.570, P = 0.005; 130-140mmHg, HR 0.864, P = 0.472). Conclusions: After AKI, a U-shaped curve association existed between average systolic BP within 48hr after AKI and composite outcome with lowest event rates in the systolic BP range of approximately 110 to 130mmHg, which suggests that too low or too high of systolic pressure (especially <110 or > 140mmHg) may be dangerous.
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