Hypotension and the noradrenaline used to treat it: both linked to postoperative AKI
Intraoperative hypotension is common in noncardiac surgery and is associated with postoperative acute kidney injury (AKI), with a population-level harm threshold around a mean arterial pressure (MAP) of 65 mm Hg. The standard reflex is to maintain MAP with vasopressors — most commonly noradrenaline. The problem: noradrenaline itself has been linked to AKI, plausibly via preferential α-receptor binding on renal afferent arterioles and consequent renal medullary hypoxia.
This leaves clinicians in a bind. If both the disease and the treatment are associated with kidney injury, which matters more — and how should that change what we do at the bedside?
The authors set out to answer one specific question: are intraoperative hypotension and the cumulative intraoperative noradrenaline dose independently associated with postoperative AKI?
Saugel B, Sander M, Katzer C, et al. Association of intraoperative hypotension and cumulative norepinephrine dose with postoperative acute kidney injury in patients having noncardiac surgery: a retrospective cohort analysis. British Journal of Anaesthesia 2025;134(1):54–62. doi:10.1016/j.bja.2024.11.005
