Comparing Norepinephrine and Phenylephrine to Prevent Kidney Injury After Surgery

This study is looking at which common medication, norepinephrine or phenylephrine, is better at preventing acute kidney injury (AKI) after major non-cardiac surgery. Low blood pressure (hypotension) during surgery is common and can lead to kidney problems. Both norepinephrine and phenylephrine are used to raise blood pressure, but it's not known which one is more effective at protecting your kidneys. You might be able to join if you are 18 or older, having surgery lasting at least 2 hours under general anesthesia, and receive vasopressors during surgery. The study aims to see if one medication leads to fewer cases of AKI within 7 days after surgery. The current recruitment status is unclear, but the study plans to enroll 18,000 participants.

Study design
This is an open-label, cluster-randomized, crossover study involving hospitals. Hospitals will switch between using phenylephrine or norepinephrine as the first-line vasopressor during different months.
What's involved
No additional lab tests or procedures will be required for the study beyond routine clinical care. Data will be collected from your electronic health record.
Compensation
Not stated in the trial record.
Follow-up
Acute kidney injury will be measured at 7 days after surgery.

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NCT06802224

The Choice of Vasopressor to Prevent Postoperative Acute Kidney Injury After Major Non-Cardiac Surgery

Recruiting
PHASE4Ages 18+InterventionalTreatment
University of California, San Francisco
~18,000 participants
Updated 2026-05-26 on ClinicalTrials.gov
What's tested:NorepinephrinePhenylephrine

At a glance

Recruiting sites
10 of 10 listed sites are recruiting right now
RecruitingSuspended, closed, or not yet open
What they're measuring
Acute Kidney Injury (AKI)
Measured over 7 days
Anesthesia
Surgery With General Anesthesia
Noncardiac Surgery
Hypotension During Surgery
Acute Kidney Injury (AKI)
Myocardial Injury After Noncardiac Surgery (MINS)
Vasopressor
10 sites across 8 states
Michigan2
North Carolina2
California1
Maryland1
Texas1
Virginia1
Washington1
Ontario1
  • Sachin Kheterpal, MD MBA · PRINCIPAL_INVESTIGATOR · University of Michigan
  • Matthieu Legrand, MD PhD · PRINCIPAL_INVESTIGATOR · University of California, San Francisco
  • Allison Janda, MD · STUDY_DIRECTOR · University of Michigan
  • Michael P Bokoch, MD PhD · STUDY_DIRECTOR · University of California, San Francisco
  • Douglas Colquhoun, MB ChB, MSc, MPH · STUDY_DIRECTOR · University of Michigan

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Eligibility criteria

Inclusion

Age 18 years or older
Surgery under general anesthesia with a surgery duration of 2 hours or more
Received intravenous vasopressors during surgery

Exclusion

Cardiac surgery
Extra-corporeal membrane oxygenation
Organ transplantation
Obstetric procedures
Procedures on the kidney
Outpatient procedures
Already receiving NE or PE or inotropes before induction of anesthesia (at the time of anesthesia start)
American Society of Anesthesiologists physical status classification 5 or 6
Patient for whom a local protocol recommends a specific first line vasopressor
Most recent documented estimated glomerular filtration rate (eGFR) \< 15 mL/min/1.73m\^2 or preoperative renal replacement therapy within 60 days before surgery
Patients who do not have a preoperative creatinine value within 60 days before surgery
Alive patients who do not have a postoperative creatinine value
  • Acute Kidney Injury (AKI)7 days

    AKI will be defined by the change of serum creatinine based on the Kidney Disease Improving Global Outcomes (KDIGO) criteria.