• Javier Ripollés-Melchor, José L Tomé-Roca, Andrés Zorrilla-Vaca, César Aldecoa, María J Colomina, Eva Bassas-Parga, Juan V Lorente, Alicia Ruiz-Escobar, Laura Carrasco-Sánchez, Marc Sadurni-Sarda, Eva Rivas, Jaume Puig, Elizabeth Agudelo-Montoya, Sabela Del Rio-Fernández, Daniel García-López, Ana B Adell-Pérez, Antonio Guillen, Rocío Venturoli-Ojeda, Bartolomé Fernández-Torres, Ane Abad-Motos, Irene Mojarro, José L Garrido-Calmaestra, Jesús Fernanz-Antón, Ana Pedregosa-Sanz, Luisa Cueva-Castro, Miren A Echevarria-Correas, Montserrat Mallol, María M Olvera-García, Rosalía Navarro-Pérez, Paula Fernández-Valdés-Bango, Javier García-Fernández, Ángel V Espinosa, Hussein Abu Khudair, Ángel Becerra-Bolaños, Yolanda Díez-Remesal, María A Fuentes-Pradera, Miguel A Valbuena-Bueno, Begoña Quintana-Villamandos, Jordi Llorca-García, Ignacio Fernández-López, Álvaro Ocón-Moreno, Sandra L Martín-Infantes, Javier M Valiente-Lourtau, Marta Amelburu-Egoscozabal, Hugo Rivera-Ramos, Alfredo Abad-Gurumeta, Manuel I Monge-García, and HYT Study Group..
• Infanta Leonor University Hospital, Madrid, Spain.
• Anesthesiology. 2025 Jan 2.

BackgroundPostoperative acute kidney injury (AKI) after major abdominal surgery leads to poor outcomes. The Hypotension Prediction Index (HPI) may aid in managing intraoperative hemodynamic instability. This study assessed if HPI-guided therapy reduces moderate-to-severe AKI incidence in moderate-to-high-risk elective abdominal surgery patients.MethodsThis multicenter randomized trial was conducted from October 2022 to February 2024 across 28 hospitals evaluating HPI-guided management compared to a wide range of real-world hemodynamic approaches. 917 patients (≥65 years or >18 years with ASA status >II) undergoing moderate-to-high-risk elective abdominal surgery were included in the intention-to-treat analysis. HPI-guided management triggered interventions when the HPI exceeded 80, using fluids and/or vasopressors/inotropes based on hemodynamic data. The primary outcome was the incidence of moderate-to-severe AKI within the first 7 days after surgery. Secondary outcomes included overall complications, the need for renal replacement therapy, duration of hospital stay, and 30-day mortality.ResultsMedian age was 71 years (IQR, 65-77) in the HPI group and 70 years (IQR, 63-76) in standard care group. ASA status III/IV was 58.3% (268/459) in the HPI group and 57.9% (263/458) in standard care group. The incidence of moderate-to-severe AKI was 6.1% (28/459) in the HPI group and 7.0% (32/458) in the standard care group (RR 0.89, 95% 0.54-1.49; P=0.66). Overall complications occurred in 31.9% (146/459) of the HPI group and 29.7% (136/458) of the standard care group (RR 1.08, 95% CI 0.85-1.37; P = 0.52). The incidence of renal replacement therapy did not differ between groups. Median length of hospital stay was 6 days (IQR, 4-10) in both groups. The 30-day mortality was 1.1% (5/459) in the HPI group versus 0.9% (4/458) in standard care group (RR 1.35, 95% CI 0.36-5.10; P = 0.66).ConclusionsHPI-guided hemodynamic therapy did not reduce the incidence of postoperative AKI or overall complications compared to standard care.Clinicaltrialsgov IdentifierNCT05569265.Copyright © 2025 American Society of Anesthesiologists. All Rights Reserved.

16 keywords...

hide…