A randomized open-label trial conducted across 39 tertiary hospitals in China found that adding dobutamine to norepinephrine during surgical source control for septic shock significantly lowered the risk of acute kidney injury (AKI). Among 584 adults, new-onset or worsening AKI within 7 postoperative days occurred in 22.8% of those receiving the combination versus 34.7% with norepinephrine alone (adjusted risk ratio 0.64, 95% CI 0.49–0.83). The study was published in JAMA and presented at the European Society of Intensive Care Medicine annual congress.
Patients in the combination group also had lower Sequential Organ Failure Assessment scores on postoperative day 1 and higher urine output shortly after the intervention began. However, the researchers found no significant differences in mortality, need for kidney replacement therapy, or hospital length of stay. Tachycardia was more frequent with dobutamine (41% vs 29.9%), but serious cardiac adverse events were comparable between groups.
The authors called the findings hypothesis-generating and noted that norepinephrine's potent vasoconstriction may reduce renal blood flow, while dobutamine's role in septic AKI prevention has been controversial. The trial restricted dobutamine to the intraoperative period, and limitations included inconsistent use of advanced hemodynamic monitoring. They suggested further exploration of treatment response across clinical subtypes.