Renin-guided Hemodynamic Management in Patients With Shock

Inclusion Criteria: * ≥18 years old * Admitted to an intensive care unit (ICU) * Requiring norepinephrine infusion at any dose to maintain a mean arterial pressure (MAP) of ≥65 mmHg after initial fluid resuscitation * Expected to stay in the ICU for at least 24 hours * Written informed consent from the patient him-/herself or the patient's next of kin as requested by the ethics committee. Exclusion Criteria: * Pregnancy * Refused informed consent * Current enrollment into another randomized controlled trial that does not allow concomitant enrollment * Requiring vasopressors for \>12 hours before the enrollment * Renal failure with an imminent need for renal replacement therapy (RRT) * Intention to use RRT by clinical judgment despite lack of urgent clinical indication * AKI stage 2 and 3 at enrollment according to the KDIGO criteria * Prior enrollment in this study * Severe liver disease (Child-Pugh score \>7 points) * Chronic kidney disease (CKD) equal to or worse than CKD stage IV (eGFR \<30 mL/min/1.73 m2) * History of kidney transplant * Any condition explicitly requiring a higher or lower blood pressure target according to clinical judgment