ArticleBritish journal of anaesthesia2025
Association of intraoperative hypotension and cumulative norepinephrine dose with postoperative acute kidney injury in patients having noncardiac surgery: a retrospective cohort analysis.
Article in British journal of anaesthesia, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 39 papers, 2 of them syntheses that pooled 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.
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.
Who cites it
39 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Accuracy and precision of continuous, non-invasive blood pressure devices: a systematic review and meta-analyses.Anaesthesia · 2026Pooled it
- Incidence and risk factors of acute kidney injury after abdominal surgery: a systematic review and meta-analysis.Annals of medicine · 2025Pooled it
- Norepinephrine infusion for prophylaxis against spinal-induced hypotension in elderly patients undergoing hip surgery: a randomized controlled comparison of two doses.BMC anesthesiology · 2026Trial
- HIgh versus STAndard blood Pressure target in hypertensive high-risk patients undergoing elective major abdominal surgery: the HISTAP multicenter randomized clinical trial.Intensive care medicine · 2026Trial
- Induction with Ciprofol Decreases Propofol Requirement During Propofol-Remifentanil Total Intravenous Anesthesia Maintenance in Elderly Patients Undergoing Total Knee Arthroplasty: A Prospective, Double-Blind, Randomized Controlled Trial.Drug design, development and therapy · 2026Trial
- Continuous versus bolus norepinephrine administration and arterial blood pressure stability during induction of general anaesthesia in high-risk noncardiac surgery patients: a randomised trial.British journal of anaesthesia · 2025Trial
- Hypotension prediction index smart alerts and trends to improve compliance with goal-directed hemodynamic therapy: a feasibility study.BMC anesthesiology · 2025Trial
- Impact of acute kidney injury in different ECMO modalities: a multicenter retrospective study on risk factors and mortality.Renal failure · 2026Article
- Beyond the numbers: hypotension, algorithms, and the elusive promise of renal protection.Annals of translational medicine · 2026Article
- Blood pressure thresholds for the administration of balanced crystalloids and the effect on intra-operative hypotension: A proof-of-concept causal inference analysis featuring idealised dynamic treatment regimens.European journal of anaesthesiology · 2026Observational
- Causal Effect and Personalization of Intraoperative Hypotension Burden on Postoperative Acute Kidney Injury: A Doubly Robust Analysis of the VitalDB Cohort.Journal of personalized medicine · 2026Article
- Reinforcement Learning for Intraoperative Hypotension Management with Consideration to Postoperative Acute Kidney Injury.Kidney360 · 2026Article
- Protective Effects of Selective β-Adrenoceptor Blockade on Renal Pathophysiology in a Catecholamine Storm of Rat.International journal of molecular sciences · 2026Article
- Frailty in anesthesia.Current opinion in anaesthesiology · 2026Review
- The association between intraoperative hypotension and postoperative acute kidney injury following emergent critical cesarean delivery: a retrospective cohort study.Journal of clinical monitoring and computing · 2026Article
- Integration of stress hyperglycemia ratio and c-reactive protein level improves postoperative acute kidney injury risk stratification after noncardiac surgery: A nested case-control study.Pakistan journal of medical sciences · 2026Article
- Physiology, monitoring, and optimisation of perioperative tissue oxygenation: a narrative review.British journal of anaesthesia · 2026Review
- Describing hemodynamic states: a plea for systematic terminology.Journal of clinical monitoring and computing · 2026Article
- Automated hemodynamic management system for the prevention of hypotension and cardiac output reduction during general anesthesia: preclinical experimental validation.Journal of anesthesia · 2026Article
- Associations of Intraoperative Hypotension and Vasopressor Administration With Postoperative Acute Kidney Injury in Children Undergoing Liver Transplantation: A Retrospective Cohort Study.Paediatric anaesthesia · 2026Article
Corrections and comments
- Erratum issued
Authors and funding
13 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundIntraoperative hypotension is associated with acute kidney injury (AKI). Clinicians thus frequently use vasopressors, such as norepinephrine, to maintain blood pressure. However, vasopressors themselves might promote AKI. We sought to determine whether both intraoperative hypotension and cumulative intraoperative norepinephrine dose are independently associated with postoperative AKI in patients undergoing noncardiac surgery.
methodsThis was a retrospective cohort analysis of 38 338 adult male and female patients who had noncardiac surgery. The primary outcome was AKI within the first 7 postoperative days. We performed adjusted multivariable logistic regression analysis to determine whether intraoperative hypotension (quantified as area under a mean arterial pressure [MAP] of 65 mm Hg) and cumulative intraoperative norepinephrine dose were independently associated with AKI.
resultsThe median (25th percentile, 75th percentile) area under a MAP of 65 mm Hg was 0.09 (0.02, 0.22) mm Hg∗day in patients with AKI and 0.05 (0.01, 0.14) mm Hg∗day in patients without AKI (P<0.001). The cumulative intraoperative norepinephrine dose was 1.92 (0.00, 13.09) μg kg
conclusionsBoth intraoperative hypotension and cumulative intraoperative norepinephrine dose were independently associated with postoperative AKI in patients undergoing noncardiac surgery. Pending results of trials testing whether these relationships are causal, it seems prudent to avoid both profound hypotension and high norepinephrine doses in adults undergoing noncardiac surgery.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
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.