INTRAOPERATIVE HYPOTENSION AND ACUTE KIDNEY INJURY: IMPACT OF HYPOTENSION INTENSITY AND DURATION ON PERIOPERATIVE RENAL OUTCOMES

Abstract

Intraoperative hypotension is one of the most frequent hemodynamic alterations during surgical procedures and is associated with relevant postoperative complications, particularly acute kidney injury. Reduced arterial pressure may compromise renal perfusion, especially in individuals with reduced functional reserve, impaired vascular autoregulation, or those undergoing major surgical procedures. This study aimed to analyze the influence of the severity and duration of intraoperative hypotension on the occurrence of acute kidney injury and other perioperative renal outcomes. An integrative literature review was conducted, prioritizing studies published between 2020 and 2026, through searches in PubMed/MEDLINE, Scopus, Web of Science, LILACS, and SciELO. Observational studies, clinical trials, systematic reviews, meta-analyses, and consensus documents addressing intraoperative blood pressure and renal outcomes were considered. The evidence identified demonstrates an association between episodes of reduced mean arterial pressure and an increased risk of acute kidney injury, particularly when mean arterial pressure remains below 65 mmHg for prolonged periods. The magnitude of blood pressure reduction and cumulative time below predefined thresholds also appear to influence renal risk in a dose-dependent manner. Factors such as advanced age, hypertension, pre-existing kidney disease, diabetes, greater surgical complexity, and vasopressor requirements may modify this relationship. Individualized hemodynamic monitoring and treatment strategies, combined with adequate assessment of volume status and early correction of the causes of hypotension, may reduce renal exposure to hypoperfusion. It is concluded that intraoperative hypotension should be assessed by jointly considering its severity, duration, and individual patient vulnerability.