{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T07:00:34Z","timestamp":1790406034500,"version":"4.1.0"},"reference-count":0,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T00:00:00Z","timestamp":1790380800000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Cardiac-surgery-associated acute kidney injury (CSA-AKI) is common and irreversible. Heavier early vasopressor use is linked to it; whether risk reflects achieved pressure or delivered dose is unclear. We describe these associations in two cohorts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Two cohorts were analysed separately (not pooled): primary (n=9,969, 705 CSA-AKI, 7.1%) and replication (n=3,292, 190, 5.8%). Exposure was cumulative first-24h vasopressor dose-load (norepinephrine-equivalent); achieved mean arterial pressure (MAP) is post-treatment. Outcome was creatinine\/renal replacement therapy (RRT)-defined KDIGO stage 2-3 within 7 days, death competing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>More vasopressor accompanied lower achieved MAP (rho -0.20 and -0.59). Higher dose-load was associated with CSA-AKI (adjusted OR per SD 1.25 [95% CI 1.16-1.35] and 2.96 [2.23-3.92]), persisting with exposure and outcome windows separated (landmark 1.22 and 3.29). Risk rose as achieved MAP fell (adjusted OR per SD 0.89 and 0.55). The highest-dose, lowest-pressure group - a descriptive high-risk haemodynamic phenotype (\"refractory\") - carried the greatest adjusted absolute excess (6.1% [3.0-9.6] and 9.9% [3.2-17.8]). Dose-load also predicted 28-day mortality, a non-renal outcome (OR 1.47 and 2.48), supporting its interpretation primarily as a marker of illness severity rather than evidence of direct kidney toxicity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>More vasopressor was not accompanied by higher achieved pressure; the patient whose dose climbs while pressure falls signals high kidney risk. These descriptive findings support recognising and monitoring this phenotype and enriching prospective trials; they establish no blood-pressure target (including 65 mmHg) and no case for dose reduction.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/joneph\/aajag247","type":"journal-article","created":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T11:27:54Z","timestamp":1790335674000},"source":"Crossref","is-referenced-by-count":0,"title":["More vasopressor, lower pressure: the refractory phenotype in cardiac-surgery AKI"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4651-5790","authenticated-orcid":false,"given":"Enes Emir","family":"Ilerler","sequence":"first","affiliation":[{"name":"Clinical Pharmacy Department, Faculty of Pharmacy, Istinye University , Istanbul ,","place":["Turkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Betul Yildiz","family":"Ustun","sequence":"additional","affiliation":[{"name":"Neurosciences Intensive Care Unit, John Radcliffe Hospital, University of Oxford , Oxford OX3 9DU ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammed Yunus","family":"Bektay","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy, Faculty of Pharmacy, Istanbul University-Cerrahpasa , Istanbul ,","place":["Turkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mesut","family":"Sancar","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy, Faculty of Pharmacy, Marmara University , Istanbul ,","place":["Turkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,9,26]]},"container-title":["Journal of Nephrology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/joneph\/advance-article-pdf\/doi\/10.1093\/joneph\/aajag247\/71400622\/aajag247.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/joneph\/advance-article-pdf\/doi\/10.1093\/joneph\/aajag247\/71400622\/aajag247.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T06:44:27Z","timestamp":1790405067000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/joneph\/advance-article\/doi\/10.1093\/joneph\/aajag247\/8836441"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,26]]},"references-count":0,"URL":"https:\/\/doi.org\/10.1093\/joneph\/aajag247","relation":{},"ISSN":["1121-8428","1724-6059"],"issn-type":[{"value":"1121-8428","type":"print"},{"value":"1724-6059","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,26]]},"article-number":"aajag247"}}