Abstract: FR-PO049
Potential Adverse Hemodynamic Effects of Higher-Intensity Continuous Renal Replacement Therapy
Session Information
- AKI: Clinical Outcomes, Trials
November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Kelly, Yvelynne P., Brigham and Women's Hospital, Boston, Massachusetts, United States
- Sharma, Shilpa, Brigham and Women's Hospital, Boston, Massachusetts, United States
- McCausland, Finnian R., Brigham and Women's Hospital, Boston, Massachusetts, United States
- Waikar, Sushrut S., Harvard Medical School, Boston, Massachusetts, United States
Background
Higher intensity continuous renal replacement therapy (CRRT) has been studied as a potential therapeutic advance for the treatment of severe acute kidney injury (AKI). We hypothesized that compared to standard intensity CRRT, higher intensity CRRT leads to greater hemodynamic instability due to the increased removal of small solutes.
Methods
Using detailed hemodynamic data recorded during the Acute Renal Failure Trial Network (ATN) trial, we assessed the incidence of hemodynamic instability in those randomized to higher (35 ml/kg/hour) versus lower intensity (20 ml/kg/hour) CRRT treatment. We used Poisson regression to model the count of hypotensive events, defined as a composite outcome including hypotension requiring an increase in vasopressor dose sufficient to increase the Sequential Organ Failure Assessment (SOFA) score, hypotension requiring cessation of RRT and hypotension requiring other interventions.
Results
Of 1124 individuals enrolled in the ATN Trial, 817 were managed with CRRT (N = 399 standard intensity and 418 higher intensity therapy). 204/817 (25%) patients experienced hypotension during the study period, with hypotensive events occurring most frequently on day 1 of treatment (Figure 1). Patients randomized to higher intensity CRRT had a 1.34-fold (95% CI, 1.02-1.76; p = 0.03) higher rate of hypotensive episodes than those randomized to standard intensity CRRT, using a Poisson model adjusted for age, gender and oliguria.
Conclusion
Higher intensity CRRT is associated with a significantly greater risk of hypotensive events compared to standard intensity CRRT.
Figure 1: Temporal distribution of hypotensive events between higher intensity and standard intensity CRRT treatment groups in the ATN trial