Dobutamine Added to Norepinephrine Lowers Kidney Injury
A randomized trial of septic shock patients undergoing surgical source control found fewer postoperative kidney injuries with the combined regimen.
Updated on Nov. 4, 2026 in Heart Disease
A randomized clinical trial published in JAMA on October 14, 2026, found that intraoperative dobutamine plus norepinephrine reduced postoperative acute kidney injury in adults with septic shock compared with norepinephrine alone. The open-label, multicenter trial enrolled 584 adults at 39 hospitals in China.
Why it matters
Septic shock is a life-threatening condition in which blood pressure and tissue oxygen delivery fall, and kidney injury is a common complication. The results suggest that adding dobutamine during surgery may help protect kidney function, though the findings may not apply to patients who do not require surgical source control.
In the randomized trial, postoperative acute kidney injury occurred in 22.8% of patients given dobutamine plus norepinephrine versus 34.7% given norepinephrine alone (adjusted risk ratio 0.64). Tachycardia was more common in the combined group at 41.0% versus 29.9%, and 28-day mortality did not differ significantly.
The players
JAMA
The Journal of the American Medical Association is a peer-reviewed medical journal published by the American Medical Association that carried the trial results.
Zhejiang University School of Medicine
A medical school in Hangzhou, China, whose affiliated lead investigator conducted the trial.
The details
Investigators randomly assigned 584 adults with septic shock across 39 hospitals in China to receive either intraoperative dobutamine up to 5 μg/kg/min plus norepinephrine or norepinephrine alone. Dobutamine acts on β-adrenergic receptors and may improve tissue perfusion, and the trial's median participant age was 67.5 years.
Timeline
October 14, 2026: Trial results published online in JAMA.
November 4, 2026: Renalandurologynews.com published its article on the findings.
Health Landscape
Dobutamine is recommended under the Surviving Sepsis Campaign guidelines for adults with septic shock and cardiac dysfunction who have persistent hypoperfusion, based on very low-certainty evidence. This trial extends that use into the operating room, testing whether intraoperative addition of dobutamine can reduce kidney injury in surgical patients.
For patients undergoing surgery for septic infection, the study suggests a possible reduction in kidney injury but also a higher rate of rapid heart rate. Patients and clinicians may weigh these tradeoffs when considering intraoperative treatment options.
The takeaway
Adding dobutamine to norepinephrine during surgery reduced kidney injury in this trial, but it increased rapid heart rate. Clinicians may weigh this tradeoff for septic shock patients who need surgical source control.
Further reading
Explore more on Heart Disease for related context on cardiovascular treatments used in critical care.
Source note: This article includes information reported by Renal and Urology News.
