Intraoperative administration of vasopressin during coronary artery bypass surgery is associated with acute postoperative kidney injury.

Vasopressin use during coronary bypass surgery was associated with a higher rate of acute kidney injury, but this association may not hold after accounting for other clinical factors.

Summary and findings

This study examined the association between intraoperative vasopressin administration and acute kidney injury (AKI) in patients undergoing coronary artery bypass surgery. Among 483 patients, AKI occurred in 14.5% overall, with 20% in the vasopressin group compared to 6.1% in controls. The study suggests that vasopressin may increase AKI risk, but further investigation is warranted.

Abstract

Background Severe vasodilatation is commonly seen upon weaning from cardiopulmonary bypass (CPB). We examined the effects of vasopressin (arginine vasopressin [AVP]) on acute kidney injury (AKI) in postoperative period. Methods The records of 483 patients undergoing coronary bypass surgery on CPB from 2004 to 2008 were retrospectively reviewed. Demographic, anthropometric, comorbid condition, and perioperative clinical/laboratory data were collected along with postoperative complications. Patients were grouped based on the perioperative use of AVP, and AKI was used as the primary end point. Univariate and multivariate logistic regression analyses were used, followed by propensity score matching for AKI. Null hypothesis was rejected at P < .05. Results Postoperative AKI occurred in 14.5% of patients. Arginine vasopressin was administered to 280 patients during the perioperative period. The prevalence of AKI in AVP was 20%, whereas it was 6.1% in controls (P < .0001). Arginine vasopressin was an independent factor that predicted the occurrence of AKI (odds ratio, 3.60; 95% confidence interval, 1.22-10.62; P = .02). However, after propensity score matching, the association between AKI and AVP was lost (P = .073). Conclusion Acute kidney injury is a common complication after cardiac surgery, and vasopressin use increases its incidence; however, this effect may rely on several clinical factors, and its true effect should be examined by large randomized trials.

Limitations

Not reported in abstract.

Elsewhere in the Vasopressin corpus