Association of Intraoperative Narrow Pulse Pressure during Normotension with Postoperative Acute Kidney Injury: A Retrospective Cohort Analysis
Main finding · Postoperative AKIResult — go to the resultOdds ratio 1.66 95% CI 1.42–1.94Authors' conclusion
Narrow pulse pressure is independently associated with postoperative AKI, even when MAP is maintained above 65 mmHg.
Study context
- Population
- Adults undergoing noncardiac surgery at a single academic medical center in South Korea (2011 to 2020)
- Participants
- 30,039 adults
- Exposure
- Narrow or wide vs reference median intraoperative pulse pressure
- Outcome
- Postoperative AKI
Methodological detailssingle-centre, entropy balancing, mechanistic substudy
- Single-centre
- Entropy balancing
- Mechanistic substudy
Main finding
As reported in the abstract
Odds ratio
1.66
95% CI 1.42–1.94
P < 0.001
Narrow vs Reference
OR 1.66 (95% CI 1.42–1.94); P < 0.001
- Overall acute kidney injury (AKI) incidence
- 6.7%
Observational data: associations, not effects.
Further findings
AKI by mean arterial pressure (MAP) × pulse pressure risk matrix (vs normotension with reference pulse pressure)
| OR (95% CI) | P value | ||
|---|---|---|---|
| Hypotension with reference pulse pressure | 1.09 (0.86–1.38) | P = 0.475 | |
| Normotension with narrow pulse pressure | 1.56 (1.27–1.89) | P < 0.001 | |
| Hypotension and narrow pulse pressure ("double hit")Highest risk | 1.85 (1.21–2.81) | ||
| 0.20.5125Odds ratio (log scale) |
Stroke volume index (mechanistic substudy)
- AKI by MAP × pulse pressure risk matrix (vs normotension with reference pulse pressure): hypotension = MAP less than 65 mmHg
Stroke volume index (mechanistic substudy)
- Significantly lower in the normotensive narrow pulse pressure group
Exposure duration
- Risk became significant after 40 min of exposure
Original publication
Association of Intraoperative Narrow Pulse Pressure during Normotension with Postoperative Acute Kidney Injury: A Retrospective Cohort Analysis. Anesthesiology. Published 17 July 2026. doi:10.
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