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Abstract: FR-PO046

Phenotypes of Volume Status in AKI Patients and Their Association with Intradialytic Hypotension

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Passos, Rogerio, Hospital Sao Rafael, Salvadir, Brazil
  • Macedo, Etienne, University of California San Diego, San Diego, California, United States
  • Teixeira, Mauricio, USP, Salvador Bahia, Brazil
  • Coelho, Fernanda O., Hospital Sao Rafael, Salvadir, Brazil
  • Melo, Érica Batista, Hospital Português da Bahia, Salvador, Brazil
  • Caldas, Juliana R., HSR, Salvador, Brazil
  • Ribeiro, Michel Pordeus, Hospital SÃo Rafael, Salvador, Brazil
  • Ramos, Joao Gabriel rosa, Hospital Sao Rafael, Salvadir, Brazil
  • Batista, Paulo benigno Pena, Hospital São Rafael, Salvador, Brazil

Group or Team Name

  • SAPIENS MI
Background

Intradialytic hypotension (IDH) is a common complication during intermittent dialysis (IHD) in hospitalized patients. It is associated delay in organ failure and renal recovery, and a common reason for modality change and continuous renal replacement therapy (CRRT) initiation. . Knowledge of patient volume status could help tailor the ultrafiltration rate and prevent episodes of IDH This study aim to evaluate the association of volume status based on sonographic profiles before IHD and occurrence and severity of IDH.
Intradialytic hypotension (IDH) is a common complication during intermittent dialysis (IHD) in hospitalized patients. It is associated delay in organ failure and renal recovery, and a common reason for modality change and continuous renal replacement therapy (CRRT) initiation. . Knowledge of patient volume status could help tailor the ultrafiltration rate and prevent episodes of IDH This study aim to evaluate the association of volume status based on sonographic profiles before IHD and occurrence and severity of IDH.

Methods

We conducted a prospective observational study including all consecutive AKI patients requiring IHD in the intensive care unit. Bedside sonography to evaluate inferior Vena Cava Colapsability (cIVC) measurement and B lines were assessed by two different trained attending physicians. Volume status profile was classified into 4 groups: (1) B Lines (+) cIVC (-); (2) B lines (+), cIVC (+); (3) B lines (-) cIVC (-); (4) B lines (-) / iICV (+)

Results

Of 248 patients 42% were classified as G1; 22% G2, 20% of group (3) and 16% of group (4) . (55%) had at least one episode of hypotension during therapy, with different frequency among the groups ( p < 0.001). Hypotension was more frequent in group (4) ( 85%), p < 0.001 versus others, and less frequent in group (1) ( 22%, p <0.001 versus others). In the multivariate adjusted analysis, the risk of IDH remained different among the groups ( p< 0.001) and group (4) exhibited the highest hazard ratio ( HR = 6.58. 95% CI 3.22- 8.24).

Conclusion

Bedside sonography assessing B lines determination and cIVC can be used to define volume status profile in critically ill patients and risk of hypotension during IHD. Further studies are needed to design adequate targeted treatments