Abstract
BackgroundIntradialytic hypotension, a complication of intermittent hemodialysis, decreases the efficacy of dialysis and increases long-term mortality. This study was aimed to determine whether different predialysis ultrasound cardiopulmonary profiles could predict intradialytic hypotension.MethodsThis prospective observational single-center study was performed in 248 critically ill patients with acute kidney injury undergoing intermittent hemodialysis. Immediately before hemodialysis, vena cava collapsibility was measured by vena cava ultrasound and pulmonary congestion by lung ultrasound. Factors predicting intradialytic hypotension were identified by multiple logistic regression analysis.ResultsIntradialytic hypotension was observed in 31.9% (n = 79) of the patients, interruption of dialysis because of intradialytic hypotension occurred in 6.8% (n = 31) of the sessions, and overall 28-day mortality was 20.1% (n = 50). Patients were classified in four ultrasound profiles: (A) 108 with B lines > 14 and vena cava collapsibility > 11.5 mm m−2, (B) 38 with B lines < 14 and vena cava collapsibility ≤ 11.5 mm m−2, (C) 36 with B lines > 14 and vena cava collapsibility Di ≤ 11.5 mm m−2, and (D) 66 with B lines < 14 and vena cava collapsibility > 11.5 mm m−2. There was an increased risk of intradialytic hypotension in patients receiving norepinephrine (odds ratios = 15, p = 0.001) and with profiles B (odds ratios = 12, p = 0.001) and C (odds ratios = 17, p = 0.001).ConclusionIn critically ill patients on intermittent hemodialysis, the absence of hypervolemia as assessed by lung and vena cava ultrasound predisposes to intradialytic hypotension and suggests alternative techniques of hemodialysis to provide better hemodynamic stability.
Highlights
Ultrafiltration-induced fluid removal for fluid balance control is a major target of renal replacement therapy [1]
In critically ill patients, intradialytic hypotension (IDH) is a frequent complication of intermittent hemodialysis and it may decrease the efficacy of renal replacement therapy [2, 3]
IDH was observed in 31.9% (n = 79) of the patients, interruption of dialysis because of IDH occurred in 6.8% (n = 31) of the sessions, and overall 28-day mortality was 20.1%
Summary
Ultrafiltration-induced fluid removal for fluid balance control is a major target of renal replacement therapy [1]. In critically ill patients, intradialytic hypotension (IDH) is a frequent complication of intermittent hemodialysis and it may decrease the efficacy of renal replacement therapy [2, 3]. Assessment of fluid overload in critically ill patients may be a challenge, because pulmonary congestion is poorly correlated with clinical signs [4]. The rate of disappearance of B lines during intermittent hemodialysis shows a good correlation with the volume of ultrafiltration and dry weight [7, 8]. Intradialytic hypotension, a complication of intermittent hemodialysis, decreases the efficacy of dialysis and increases long-term mortality. This study was aimed to determine whether different predialysis ultrasound cardiopulmonary profiles could predict intradialytic hypotension
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
