HYT
Trial question
What is the role of Hypotension Prediction Index-guided hemodynamic therapy in patients undergoing moderate-to-high-risk elective abdominal surgery?
Study design
Multi-center
Open label
RCT
Population
917 patients.
Inclusion criteria: patients undergoing moderate-to-high-risk elective abdominal surgery.
Key exclusion criteria: stage 4 or 5 CKD; renal transplantation in the previous 12 months; glomerulonephritis, interstitial nephritis, or vasculitis; anuria; pre-existing AKI; RRT in the last 90 days; indication for renal replacement; AF; cardiac shunts; urgent surgical indication; imminent death within 30 days.
Interventions
N=459 HPI-guided management (Hypotension Prediction Index-based goal-directed hemodynamic therapy).
N=458 standard care (treatment according to standard practice).
Primary outcome
Rate of moderate-to-severe acute kidney injury within the first 7 days after surgery
6.1%
7%
7.0 %
5.3 %
3.5 %
1.8 %
0.0 %
HPI-guided
management
Standard
care
No significant
difference ↔
No significant difference in the rate of moderate-to-severe AKI within the first 7 days after surgery (6.1% vs. 7%; RR 0.89, 95% CI 0.54 to 1.49).
Secondary outcomes
No significant difference in overall complications (31.9% vs. 29.7%; RR 1.08, 95% CI 0.85 to 1.37).
No significant difference in death at day 30 (1.1% vs. 0.9%; RR 1.35, 95% CI 0.36 to 5.1).
Conclusion
In patients undergoing moderate-to-high-risk elective abdominal surgery, HPI-guided management was not superior to standard care with respect to the rate of moderate-to-severe AKI within the first 7 days after surgery.
Reference
Javier Ripollés-Melchor, José L Tomé-Roca, Andrés Zorrilla-Vaca et al. Hemodynamic Management guided by the Hypotension Prediction Index in Abdominal Surgery: A Multicenter Randomized Clinical Trial. Anesthesiology. 2025 Jan 2. Online ahead of print.
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