Evidence map›Paper›PMID 35024154›Full record

ArticleCanadian journal of kidney health and disease2022

Effect of a Perioperative Hypotension-Avoidance Strategy Versus a Hypertension-Avoidance Strategy on the Risk of Acute Kidney Injury: A Clinical Research Protocol for a Substudy of the POISE-3 Randomized Clinical Trial.

Amit X Garg, Meaghan Cuerden, Hector Aguado, Mohammed Amir, Emilie P Belley-Cote, Keyur Bhatt, Bruce M Biccard, Flavia K Borges, Matthew Chan, David Conen and 46 more

Abstract read
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In one paragraph

Article in Canadian journal of kidney health and disease, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Trial
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

56 authors.

Amit X GargLondon Health Sciences Centre, ON, Canada.ORCID https://orcid.org/0000-0003-3398-3114
Meaghan CuerdenLondon Health Sciences Centre, ON, Canada.
Hector AguadoHospital Clínico Universitario de Valladolid, Spain.
Mohammed AmirShifa International Hospital (STMU), Islamabad, Pakistan.
Emilie P Belley-CoteMcMaster University, Hamilton, ON, Canada.
Keyur BhattSIDS Hospital & Research Centre, Guntur, India.
Bruce M BiccardGroote Schuur Hospital, Cape Town, South Africa.
Flavia K BorgesPopulation Health Research Institute, Hamilton, ON, Canada.
Matthew ChanThe Chinese University of Hong Kong, Shatin, Hong Kong.
David ConenPopulation Health Research Institute, Hamilton, ON, Canada.
Emmanuelle DuceppePopulation Health Research Institute, Hamilton, ON, Canada.
Sergey EfremovSaint Petersburg State University, Russia.
John EikelboomMcMaster University, Hamilton, ON, Canada.
Edith FleischmannMedical University of Vienna, Austria.
Landoni GiovanniIstituto Scientifico Universitario San Raffaele, Milan, Italy.
Peter GrossMcMaster University, Hamilton, ON, Canada.
Raja JayaramUniversity of Oxford, UK.
Mikhail KirovNorthern State Medical University of the Ministry of Healthcare of the Russian Federation, Arkhangelsk, Russia.
Ydo KleinlugtenbeltDeventer Ziekenhuis, The Netherlands.
Andrea KurzMedical University of Graz, Austria.
Andre LamyPopulation Health Research Institute, Hamilton, ON, Canada.
Kate LeslieThe Royal Melbourne Hospital, VIC, Austria.
Valery LikhvantsevI. M. Sechenov Moscow Medical Academy, Russia.
Vladimir LomivorotovNovosibirsk State University, Russia.
Maura MarcucciMcMaster University, Hamilton, ON, Canada.
Maria José Martínez-ZapataCentro Cochrane Iberoamericano, Barcelona, Spain.
Michael McGillionMcMaster University, Hamilton, ON, Canada.
William McIntyrePopulation Health Research Institute, Hamilton, ON, Canada.
Christian MeyhoffUniversity of Copenhagen, Denmark.
Sandra OforiPopulation Health Research Institute, Hamilton, ON, Canada.
Thomas PainterRoyal Adelaide Hospital, SA, Australia.
Pilar PaniaguaHospital de la Santa Creu i Sant Pau, Barcelona, Spain.
Chirag ParikhJohns Hopkins University, Baltimore, MD, USA.
Joel ParlowKingston General Hospital, ON, Canada.
Ameen PatelMcMaster University, Hamilton, ON, Canada.
Carisi PolanczykHospital de Clinicas de Porto Alegre, Brazil.
Toby RichardsThe University of Western Australia, Perth, Australia.
Pavel RoshanovWestern University, London, ON, Canada.
Denis SchmartzCHU Brugmann, Brussels, Belgium.
Daniel SesslerCleveland Clinic, OH, USA.
Tim ShortAuckland District Health Board, New Zealand.
Jessica M SontropWestern University, London, ON, Canada.ORCID https://orcid.org/0000-0001-7784-2028
Jessica SpenceMcMaster University, Hamilton, ON, Canada.
Sadeesh SrinathanUniversity of Manitoba, Winnipeg, Canada.
David StilloPopulation Health Research Institute, Hamilton, ON, Canada.
Wojciech SzczeklikJagiellonian University, Krakow, Poland.
Vikas TandonMcMaster University, Hamilton, ON, Canada.
David TorresClinica Santa Maria, Santiago, Chile.
Thomas Van HelderHamilton Health Sciences, ON, Canada.
Jessica VincentPopulation Health Research Institute, Hamilton, ON, Canada.
C Y WangUniversity of Malaya, Kuala Lumpur, Malaysia.
Michael WangMcMaster University, Hamilton, ON, Canada.ORCID https://orcid.org/0000-0002-4949-3235
Richard WhitlockPopulation Health Research Institute, Hamilton, ON, Canada.
Maria WittmannUniversitätsklinikum Bonn, Germany.
Denis XavierSt. John's National Academy of Health Sciences, Bangalore, India.
P J DevereauxMcMaster University, Hamilton, ON, Canada.

Funding

Yale Clinical and Translational Science Award (U Component)UL1TR001863 · NCATS · YALE UNIVERSITY · PI John H. Krystal, LUCILA OHNO-MACHADO · 2016 to 2026
$102.9M
NCATS NIH HHS UL1 TR001863
6 · The paper itself

Abstract

backgroundMost patients who take antihypertensive medications continue taking them on the morning of surgery and during the perioperative period. However, growing evidence suggests this practice may contribute to perioperative hypotension and a higher risk of complications. This protocol describes an acute kidney injury substudy of the Perioperative Ischemic Evaluation-3 (POISE-3) trial, which is testing the effect of a perioperative hypotension-avoidance strategy versus a hypertension-avoidance strategy in patients undergoing noncardiac surgery.

objectiveTo conduct a substudy of POISE-3 to determine whether a perioperative hypotension-avoidance strategy reduces the risk of acute kidney injury compared with a hypertension-avoidance strategy.

designRandomized clinical trial with 1:1 randomization to the intervention (a perioperative hypotension-avoidance strategy) or control (a hypertension-avoidance strategy).

interventionIf the presurgery systolic blood pressure (SBP) is <130 mmHg, all antihypertensive medications are withheld on the morning of surgery. If the SBP is ≥130 mmHg, some medications (but not angiotensin receptor blockers [ACEIs], angiotensin receptor blockers [ARBs], or renin inhibitors) may be continued in a stepwise manner. During surgery, the patients' mean arterial pressure (MAP) is maintained at ≥80 mmHg. During the first 48 hours after surgery, some antihypertensive medications (but not ACEIs, ARBs, or renin inhibitors) may be restarted in a stepwise manner if the SBP is ≥130 mmHg. CONTROL: Patients receive their usual antihypertensive medications before and after surgery. The patients' MAP is maintained at ≥60 mmHg from anesthetic induction until the end of surgery.

settingRecruitment from 108 centers in 22 countries from 2018 to 2021. PATIENTS: Patients (~6800) aged ≥45 years having noncardiac surgery who have or are at risk of atherosclerotic disease and who routinely take antihypertensive medications. MEASUREMENTS: The primary outcome of the substudy is postoperative acute kidney injury, defined as an increase in serum creatinine concentration of either ≥26.5 μmol/L (≥0.3 mg/dL) within 48 hours of randomization or ≥50% within 7 days of randomization.

methodsThe primary analysis (intention-to-treat) will examine the relative risk and 95% confidence interval of acute kidney injury in the intervention versus control group. We will repeat the primary analysis using alternative definitions of acute kidney injury and examine effect modification by preexisting chronic kidney disease, defined as a prerandomization estimated glomerular filtration rate <60 mL/min/1.73 m

resultsSubstudy results will be analyzed in 2022. LIMITATIONS: It is not possible to mask patients or providers to the intervention; however, objective measures will be used to assess acute kidney injury.

conclusionsThis substudy will provide generalizable estimates of the effect of a perioperative hypotension-avoidance strategy on the risk of acute kidney injury.

Indexed as

acute kidney injuryantihypertensive medicationhypotensionmean arterial pressurenoncardiac surgery

Identifiers

PMID35024154
PMCPMC8744204

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.