Abstract: SA-PO091

Effect of Low Dialysate Temperature on Blood Pressure During SLED in Patients with AKI

Session Information

Category: Acute Kidney Injury

  • 003 AKI: Clinical and Translational

Authors

  • Edrees, Fahad Y., Washington University in St. Louis, St. Louis, Missouri, United States
  • Vijayan, Anitha, Washington University in St. Louis, St. Louis, Missouri, United States
Background

AKI requiring RRT is associated with high mortality and morbidity. Intradialytic hypotension (IDH) may delay renal recovery by perpetuating ischemic injury. Studies have shown that lowering dialysate temperature to 35.5-36°C in ESRD patients is associated with decrease in the incidence of IDH. However, data in AKI patients undergoing CRRT or sustained low-efficiency dialysis (SLED) are scarce. We conducted a prospective, randomized, cross-over study to evaluate the effect of lower dialysate temperature on the hemodynamic status of critically ill patients with AKI during SLED.

Methods

We obtained approval from Washington University IRB. Patients were randomized to start SLED on either high (37°C) (Group A) or low (35°C) dialysate temperature (Group B) and then alternate treatments. Patients who had a single treatment, required antihypertensive medication after enrollment, or were on 3 pressers before starting treatment were excluded. SLED was performed using the NxStage System One®, with blood flow at 300ml/min and dialysate flow of 33 -126ml/min. Hypotensive event was defined by any of the following: ↓SBP ≥ 20mmHg, ↓MAP ≥ 10mmHg, decrease in ultrafiltration or change in vasopressors requirement. The number of events was analyzed by Poisson regression and other outcomes with repeated-measures ANOVA.

Results

We enrolled 21 patients who underwent a total of 78 SLED sessions, 39 in each arm. The mean age was 56.1 and mean SOFA score at time of enrollment 9.4 ± 2.6. There was doubling of hypotensive events in high temperature (1.4±1.0) compared to low temperature (0.7±0.6) sessions (P=0.007).(Table1)

Conclusion

AKI patients undergoing SLED with low dialysate temperature, experience significantly less intradialytic HoTN. Prevention of IDH may help to achieve UF targets, thereby preventing volume overload and may also help to promote renal recovery. A larger study is required to confirm our findings.

Primary and Secondary Outcomes
OutcomeEstimate ± SEMMean ± SEMIRR95% CIp-value
  High TempLow Temp   
Events0.75 ± 0.141.4 ± 1.00.7 ± 0.62.111.59 - 2.790.007
Ultrafiltration Difference238 ± 104421 ± 78182 ± 79 21 - 4560.03
Ultrafitration % Achieved-8.0 ± 4.184.0 ± 32.393.0 ± 3.3 -17 - -0.260.04
Lowest temp during SLED0.02 ± 0.1036.6 ± 0.136.5 ± 0.1 -0.20 - 0.230.88
Temp at end of SLED0.10 ± 0.1436.9 ± 0.136.8 ± 0.1 -0.19 - 0.380.48
Kt/Vurea-0.03 ± 0.030.78 ± 0.040.81 ± 0.04 -0.09 - 0.030.28
URR-1.71 ± 1.3242.9 ± 2.144.6 ± 2.1 -4.56 -1.140.22

IRR- incidence rate ratio; URR: urea reduction ratio