Exploring the Role of Central Venous Pressure in Cardiac Surgery-Associated Acute Kidney Injury: A Comprehensive Scoping Review

TL;DR

This review explores how high central venous pressure may contribute to kidney injury in heart surgery patients and suggests monitoring it could help prevent complications.

Contribution

The review systematically maps evidence linking central venous pressure to acute kidney injury in cardiac surgery, highlighting gaps for future research.

Findings

Elevated central venous pressure is positively associated with postoperative acute kidney injury in CABG patients.

Thresholds for central venous pressure linked to AKI vary across studies, with intraoperative ranges of 6.5–12 mm Hg and postoperative >6.6–10.3 mm Hg.

High central venous pressure combined with low mean arterial pressure shows a synergistic effect in increasing AKI risk.

Abstract

Acute kidney injury (AKI) is a critical complication, affecting up to 30% of coronary artery bypass grafting (CABG) patients, and contributing to significant morbidity and mortality. Recent studies indicate that increased central venous pressure (CVP) might significantly contribute to the development of AKI by causing venous congestion and impairing renal blood flow. However, the association between CVP and AKI in patients undergoing CABG has not been thoroughly investigated. This scoping review evaluates the current evidence on CVP as a hemodynamic marker associated with AKI in adults undergoing cardiac surgery with cardiopulmonary bypass (CPB), with a particular focus on CABG where reported.

This scoping review, conducted over 12 weeks, followed the PRISMA-ScR guidelines and Arksey and O’Malley framework. A systematic search of PubMed, Scopus, Web of Science, and MEDLINE (2016–2024) identified studies on adult CPB-supported cardiac surgery, including CABG. Eligible studies reported quantitative CVP (intra- or postoperative) and standardized AKI criteria. No formal bias assessment was performed; data extraction was independently conducted by two reviewers using a standardized form.

Of 1,717 studies screened, 16 met the inclusion criteria, mostly retrospective cohorts involving CABG patients. Overall, elevated CVP showed a positive association with postoperative AKI, though thresholds varied (intraoperative 6.5–12 mm Hg; postoperative>6.6–10.3 mm Hg). Several studies revealed a synergistic effect between high CVP and low mean arterial pressure (MAP). Despite consistent trends, heterogeneity in design and CVP assessment limits comparability. Most studies used the KDIGO criteria for AKI definition.

High CVP is commonly linked to the occurrence of AKI in patients undergoing cardiac surgery. The evidence mapped in this review suggests a potential role for CVP monitoring in perioperative care, though clinical recommendations require validation through prospective trials. Future research should focus on establishing standardized CVP thresholds and evaluating their utility in AKI risk stratification.

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