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01). After NSBB, RPP dropped below the threshold of renal flow autoregulation in 11 of the 20 (55%) RA patients, including the 4 fulfilling HRS-AKI criteria. Conclusion Renal perfusion and function depend critically of systolic function and sympathetic hyperactivation in RA. NSBB blunt the sympathetic overdrive on cardiac function, hamper cardiac output, lower RPP below the critical threshold and impair renal function.-blockade should be cautious or even avoided in RA.Background Inclusion of all patients with advanced biliary tract cance