Indian journal of anaesthesia · 2026
Comparison of the Hypotension Prediction Index and pulse pressure variation-guided haemodynamic management for intra-operative hypotension during kidney transplant: A randomised controlled trial.
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Aditya Ashish S, Kajal Kamal, Sethi Sameer, Premkumar Madhumita, Naik Naveen, Sharma Ashish
Аннотация
BACKGROUND AND AIMS: Intra-operative hypotension (IOH) adversely affects renal graft and recipient outcomes. The Hypotension Prediction Index (HPI), a machine learning-based algorithm, predicts IOH. This study compared HPI- versus pulse pressure variation (PPV)-guided haemodynamic management in kidney transplantation, hypothesising that HPI guidance would reduce intra-operative hypotension.
METHODS: In this single-centre randomised controlled trial, 82 patients with end-stage renal disease (ESRD) undergoing live-related kidney transplantation under general anaesthesia were randomised to HPI-guided (n = 41) or PPV-guided (n = 41) haemodynamic management. The primary outcome was the time-weighted average area under the threshold (TWA-AUT) of mean arterial pressure (MAP) <65 mmHg. Secondary outcomes included absolute area under the threshold (AUT), the number and total duration of hypotensive episodes per patient, and the proportion of patients with MAP <50 mmHg. Delayed graft function, serum creatinine on post-operative day 3, hospital stay, and 90-day mortality were also compared.
RESULTS: The results were analysed for 82 patients. The median [interquartile range (IQR)] TWA-AUT <65 mmHg was 0.10 mmHg [0.04-0.17] in the HPI group and 0.16 mmHg [0.06-0.32] in the PPV group, with a median difference of -0.05 mmHg [95% confidence interval (CI): -0.18 to 0.01; P = 0.09]. The median AUT was 24.8 mmHg·min in the HPI group and 43.3 mmHg × min in the PPV group (P = 0.10). Hypotensive events occurred in 47% of patients in the HPI group versus 61% in the PPV group (P = 0.16). No significant differences were observed in the secondary outcomes between the groups.
CONCLUSION: HPI-guided haemodynamic management did not significantly reduce the time-weighted average of intra-operative hypotension during renal transplant surgery compared to PPV-guided haemodynamic management.
METHODS: In this single-centre randomised controlled trial, 82 patients with end-stage renal disease (ESRD) undergoing live-related kidney transplantation under general anaesthesia were randomised to HPI-guided (n = 41) or PPV-guided (n = 41) haemodynamic management. The primary outcome was the time-weighted average area under the threshold (TWA-AUT) of mean arterial pressure (MAP) <65 mmHg. Secondary outcomes included absolute area under the threshold (AUT), the number and total duration of hypotensive episodes per patient, and the proportion of patients with MAP <50 mmHg. Delayed graft function, serum creatinine on post-operative day 3, hospital stay, and 90-day mortality were also compared.
RESULTS: The results were analysed for 82 patients. The median [interquartile range (IQR)] TWA-AUT <65 mmHg was 0.10 mmHg [0.04-0.17] in the HPI group and 0.16 mmHg [0.06-0.32] in the PPV group, with a median difference of -0.05 mmHg [95% confidence interval (CI): -0.18 to 0.01; P = 0.09]. The median AUT was 24.8 mmHg·min in the HPI group and 43.3 mmHg × min in the PPV group (P = 0.10). Hypotensive events occurred in 47% of patients in the HPI group versus 61% in the PPV group (P = 0.16). No significant differences were observed in the secondary outcomes between the groups.
CONCLUSION: HPI-guided haemodynamic management did not significantly reduce the time-weighted average of intra-operative hypotension during renal transplant surgery compared to PPV-guided haemodynamic management.