{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T20:05:32Z","timestamp":1791317132531,"version":"4.3.1"},"reference-count":24,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:sec>\n            <jats:title>OBJECTIVES:<\/jats:title>\n            <jats:p>The relationship between renin levels, exposure to renin-angiotensin system (RAS) inhibitors, angiotensin II (ANGII) responsiveness, and outcome in patients with vasopressor-dependent vasodilatory hypotension is unknown.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>DESIGN:<\/jats:title>\n            <jats:p>We conducted a single-center prospective observational study to explore whether recent RAS inhibitor exposure affected baseline renin levels, whether baseline renin levels predicted ANGII responsiveness, and whether renin levels at 24 hours were associated with clinical outcomes.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>SETTING:<\/jats:title>\n            <jats:p>An academic ICU in Melbourne, VIC, Australia.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>PATIENTS:<\/jats:title>\n            <jats:p>Forty critically ill adults who received ANGII as the primary agent for vasopressor-dependent vasodilatory hypotension who were included in the Acute Renal effects of Angiotensin II Management in Shock study.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>INTERVENTIONS:<\/jats:title>\n            <jats:p>None.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>MEASUREMENTS AND MAIN RESULTS:<\/jats:title>\n            <jats:p>After multivariable adjustment, recent exposure to a RAS inhibitor was independently associated with a relative increase in baseline renin levels by 198% (95% CI, 36\u2013552%). The peak amount of ANGII required to achieve target mean arterial pressure was independently associated with baseline renin level (increase by 46% per ten-fold increase; 95% CI, 8\u201398%). Higher renin levels at 24 hours after ANGII initiation were independently associated with fewer days alive and free of continuous renal replacement therapy (CRRT) (\u20137 d per ten-fold increase; 95% CI, \u201312 to \u20131).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>CONCLUSIONS:<\/jats:title>\n            <jats:p>In patients with vasopressor-dependent vasodilatory hypotension, recent RAS inhibitor exposure was associated with higher baseline renin levels. Such higher renin levels were then associated with decreased ANGII responsiveness. Higher renin levels at 24 hours despite ANGII infusion were associated with fewer days alive and CRRT-free. These preliminary findings emphasize the importance of the RAS and the role of renin as a biomarker in patients with vasopressor-dependent vasodilatory hypotension.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/ccm.0000000000006273","type":"journal-article","created":{"date-parts":[[2024,3,21]],"date-time":"2024-03-21T14:00:26Z","timestamp":1711029626000},"page":"1218-1227","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":20,"title":["Renin Levels and Angiotensin II Responsiveness in Vasopressor-Dependent Hypotension*"],"prefix":"10.1097","volume":"52","author":[{"given":"Emily J.","family":"See","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anis","family":"Chaba","sequence":"additional","affiliation":[{"name":"Department of Intensive Care, Austin Hospital, Heidelberg, VIC, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sofia","family":"Spano","sequence":"additional","affiliation":[{"name":"Department of Intensive Care, Austin Hospital, Heidelberg, VIC, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akinori","family":"Maeda","sequence":"additional","affiliation":[{"name":"Department of Intensive Care, Austin Hospital, Heidelberg, VIC, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline","family":"Clapham","sequence":"additional","affiliation":[{"name":"Department of Intensive Care, Austin Hospital, Heidelberg, VIC, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louise M.","family":"Burrell","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Melbourne, Parkville, VIC, Australia."},{"name":"Institute of Breathing and Sleep, Austin Health, Melbourne, VIC, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jasmine","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Intensive Care, Austin Hospital, Heidelberg, VIC, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monique","family":"Khasin","sequence":"additional","affiliation":[{"name":"Department of Intensive Care, Austin Hospital, Heidelberg, VIC, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grace","family":"Liskaser","sequence":"additional","affiliation":[{"name":"Department of Intensive Care, Austin Hospital, Heidelberg, VIC, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Glenn","family":"Eastwood","sequence":"additional","affiliation":[{"name":"Department of Intensive Care, Austin Hospital, Heidelberg, VIC, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rinaldo","family":"Bellomo","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Melbourne, Parkville, VIC, Australia."},{"name":"Data Analytics Research and Evaluation Centre, The University of Melbourne and Austin Hospital, Melbourne, VIC, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2024,3,21]]},"reference":[{"key":"R1-20250502","doi-asserted-by":"crossref","first-page":"1181","DOI":"10.1007\/s00134-021-06506-y","article-title":"Surviving sepsis campaign: International guidelines for management of sepsis and septic shock 2021.","volume":"47","author":"Evans","year":"2021","journal-title":"Intensive Care Med"},{"key":"R2-20250502","doi-asserted-by":"crossref","first-page":"664","DOI":"10.1378\/chest.12-1106","article-title":"Survival after shock requiring high-dose vasopressor 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