Key result
Individualized intraoperative blood pressure management using norepinephrine did not significantly reduce the incidence of acute kidney injury compared to usual care (13.5% vs 14.3%).
Why the study?
It was uncertain whether individualized intraoperative blood pressure control with norepinephrine reduces acute kidney injury and urine concentration in older patients undergoing major abdominal surgery.
Does individualized intraoperative blood pressure control with norepinephrine reduce acute kidney injury in older patients with hypertension undergoing major abdominal surgery?
RCT (n=166)
randomly assigned
No
Does individualized intraoperative blood pressure control with norepinephrine reduce acute kidney injury in older patients with hypertension undergoing major abdominal surgery?
Individualized intraoperative blood pressure control with norepinephrine in older patients undergoing major abdominal surgery reduces kidney injury biomarkers but does not significantly reduce the incidence of clinical acute kidney injury.
Answers are grounded in this paper and cite their sources.
Does not support individualized BP management with norepinephrine to prevent clinical AKI; leaves open biomarker-clinical endpoint dissociation in hypertensive surgical patients.
BACKGROUND: This randomized trial aimed to determine whether achievement of individualized blood pressure targets through norepinephrine administration can mitigate acute kidney injury (AKI) and reduce urine concentration, which serves as a surrogate marker for fluid retention, in older patients undergoing major abdominal surgery. METHODS: This study included 166 patients aged 55-80 years who were scheduled to undergo gastrectomy or colorectal cancer resection. They were randomly assigned to the individualized care group, in which systolic blood pressure or mean arterial pressure was maintained within ± 10% and ± 20% of baseline, respectively, using norepinephrine; or to the usual care group, in which mean arterial pressure was maintained at ≥ 65 mmHg without individualized titration. Individuals in both groups underwent continuous arterial monitoring and goal-directed fluid therapy. AKI was diagnosed based on the Kidney Disease: Improving Global Outcomes criteria. Further, renal injury was assessed based on serum neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1) levels. Urine concentration scores were calculated from the urine parameters. RESULTS: AKI occurred in 13.5% and 14.3% of patients in the individualized and usual care groups, respectively. Patients in the usual care group experienced significant intraoperative fluctuations in mean arterial pressure. Norepinephrine was administered to 80.9% and 17.1% of patients in the individualized and usual care groups, respectively. Compared with the usual care group, the individualized care group demonstrated reduced NGAL levels and KIM-1 levels at the end of surgery and on postoperative day 2, and lower urine concentration scores at the end of surgery and on postoperative day 1. CONCLUSION: Individualized blood pressure management using norepinephrine mitigated kidney damage, as indicated by elevated biomarkers, and decreased urine concentration, a surrogate indicator of fluid retention. However, it did not significantly reduce the incidence of AKI. TRIAL REGISTRATION: This trial was registered in the Chinese Clinical Trial Registry (ChiCTR2100049843) on August 10, 2021 ( https://www.chictr.org.cn/ ).
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Li et al. (2026) conducted an RCT in hypertension undergoing major abdominal surgery (n=166). Individualized blood pressure management using norepinephrine vs. usual care (mean arterial pressure maintained at ≥ 65 mmHg) was evaluated on Acute kidney injury (AKI). Individualized intraoperative blood pressure management using norepinephrine did not significantly reduce the incidence of acute kidney injury compared to usual care (13.5% vs 14.3%).
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