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Prediction of Hemodynamic Tolerance of Intermittent Hemodialysis in Critically Ill Patients: a Cohort Study

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Journal Sci Rep
Specialty Science
Date 2021 Dec 9
PMID 34880359
Citations 2
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Abstract

The evaluation and management of fluid balance are key challenges when caring for critically ill patients requiring renal replacement therapy. The aim of this study was to assess the ability of clinical judgment and other variables to predict the occurrence of hypotension during intermittent hemodialysis (IHD) in critically ill patients. This was a prospective, observational, single-center study involving critically ill patients undergoing IHD. The clinical judgment of hypervolemia was determined by the managing nephrologists and critical care physicians in charge of the patients on the basis of the clinical data used to calculate the ultrafiltration volume and rate for each dialysis treatment. Seventy-nine (31.9%) patients presented with hypotension during IHD. Patients were perceived as being hypervolemic in 109 (43.9%) of the cases by nephrologists and in 107 (43.1%) by intensivists. The agreement between nephrologists and intensivists was weak (kappa = 0.561). Receiver operating characteristic curve analysis yielded an AUC of 0.81 (95% CI 0.75 to 0.84; P < 0.0001), and a cutoff value of 70 mm for the vascular pedicle width (VPW) had the highest accuracy for the prediction of the absence of hypotension. The clinical judgment of hypervolemia did not predict hypotension during IHD. The high predictive ability of the VPW may assist clinicians with critical thinking.

Citing Articles

Prevalence of cardiovascular instability during hemodialysis therapy in hospitalized patients: A systematic review and meta-analysis.

Arcentales-Vera K, Vera-Mendoza M, Cevallos-Salas C, Garcia-Aguilera M, Fuenmayor-Gonzalez L Sci Prog. 2024; 107(4):368504241308982.

PMID: 39726219 PMC: 11686621. DOI: 10.1177/00368504241308982.


Predictors of intradialytic hypotension in critically ill patients undergoing kidney replacement therapy: a systematic review.

Lyrio R, Macedo E, Murugan R, da Silva A, Calcagno T, Sampaio E Intensive Care Med Exp. 2024; 12(1):106.

PMID: 39570485 PMC: 11582124. DOI: 10.1186/s40635-024-00695-8.

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