Renal resistive index-guided mean arterial pressure titration in sepsis: a prospective single-center, single-blind, parallel-group randomized controlled trial.
Summary
In this single-center RCT (n=274), RRI-guided MAP titration improved renal resistive index compared with usual care but did not reduce 28-day mortality (RR 0.69; 95% CI 0.44–1.08). The trial supports that physiologic optimization of renal perfusion indices alone may not translate into survival benefit.
Key Findings
- RRI decreased significantly after titration in the intervention group vs control (0.61 vs 0.67; P<0.001).
- No significant reduction in 28-day all-cause mortality (25/138 vs 36/136; RR 0.69, 95% CI 0.44–1.08; P=0.11).
- Single-center, single-blind RCT suggests improved renal hemodynamics did not translate into survival benefit.
Clinical Implications
Do not adopt RRI-guided MAP titration solely to reduce mortality in sepsis. Consider RRI as a renal hemodynamics tool rather than a mortality-targeting strategy; future protocols should evaluate patient selection and kidney-centered outcomes.
Why It Matters
Provides high-quality randomized evidence clarifying that an RRI-guided hemodynamic strategy does not improve survival, tempering enthusiasm for organ-specific MAP targets in sepsis.
Limitations
- Single-center design may limit generalizability.
- Potentially underpowered to detect modest mortality effects; external replication lacking.
Future Directions
Multicenter RCTs assessing personalized MAP targets incorporating renal and systemic perfusion metrics, with kidney-specific endpoints and cost–benefit analyses.
Study Information
- Study Type
- RCT
- Research Domain
- Treatment
- Evidence Level
- I - Randomized controlled trial with prospective registration, single-center, single-blind.
- Study Design
- OTHER