Abstract

BackgroundIntradialytic hypotension is a serious complication during renal replacement therapy in critically ill patients. Early prediction of intradialytic hypotension could allow adequate prophylactic measures. In this study we evaluated the ability of peripheral perfusion index (PPI) and heart rate variability (HRV) to predict intradialytic hypotension.MethodsA prospective observational study included 36 critically ill patients with acute kidney injury during their first session of intermittent hemodialysis. In addition to basic vital signs, PPI was measured using Radical-7 (Masimo) device. Electrical cardiometry (ICON) device was used for measuring cardiac output, systemic vascular resistance, and HRV. All hemodynamic values were recorded at the following time points: 30 min before the hemodialysis session, 15 min before the start of hemodialysis session, every 5 min during the session, and 15 min after the conclusion of the session. The ability of all variables to predict intradialytic hypotension was assessed through area under receiver operating characteristic (AUROC) curve calculation.ResultsTwenty-three patients (64%) had intradialytic hypotension. Patients with pulmonary oedema showed higher risk for development of intradialytic hypotension {Odds ratio (95% CI): 13.75(1.4–136)}. Each of baseline HRV, and baseline PPI showed good predictive properties for intradialytic hypotension {AUROC (95% CI): 0.761(0.59–0.88)}, and 0.721(0.547–0.857)} respectively.ConclusionsEach of low PPI, low HRV, and the presence of pulmonary oedema are good predictors of intradialytic hypotension.

Highlights

  • Intradialytic hypotension is a serious complication during renal replacement therapy in critically ill patients

  • No data are available for the validity of peripheral perfusion index (PPI) in early prediction of hypotension during intermittent hemodialysis

  • The aim of this work was to evaluate the ability of PPI and electrical cardiometry-derived heart rate variability (HRV) to predict hypotension in critically ill patients during intermittent hemodialysis

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Summary

Introduction

Intradialytic hypotension is a serious complication during renal replacement therapy in critically ill patients. Prediction of intradialytic hypotension could allow adequate prophylactic measures. In this study we evaluated the ability of peripheral perfusion index (PPI) and heart rate variability (HRV) to predict intradialytic hypotension. Intermittent hemodialysis is one of the commonly used routes for renal replacement therapy [1]. Intradialytic hypotension is a common complication during renal replacement therapy due to volume removal, changes in plasma osmolality, and autonomic dysfunction. Peripheral Perfusion Index (PPI) is defined as “the ratio of pulsatile blood flow to the non-pulsatile blood flow”. As PPI is generally affected by sympathetic tone, it was a useful early predictor for the need of vasopressors in patients with severe sepsis [4]. No data are available for the validity of PPI in early prediction of hypotension during intermittent hemodialysis

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