Abstract: FR-PO121
Impact of Using Blood Warmer During Continuous Kidney Replacement Therapy on Hemodynamic Instability
Session Information
- AKI: Outcomes, RRT
November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Doddi, Akshith, West Virginia University Health Sciences Center, Morgantown, West Virginia, United States
- Abbasi, Aisha, West Virginia University Health Sciences Center, Morgantown, West Virginia, United States
- Ramesh, Ambika, West Virginia University Health Sciences Center, Morgantown, West Virginia, United States
- Moursy, Safa, West Virginia University Health Sciences Center, Morgantown, West Virginia, United States
- Sakhuja, Ankit, West Virginia University Health Sciences Center, Morgantown, West Virginia, United States
- Shawwa, Khaled, West Virginia University Health Sciences Center, Morgantown, West Virginia, United States
Background
Continuous kidney replacement therapy (CKRT) can lead to heat loss in the extracorporeal circulation. Hypothermia may have detrimental effects; however, rewarming of blood may alter vascular reactivity and induce hypotension.
Methods
We screened patients with acute kidney injury (AKI) who required CKRT between 1/1/2012 and 1/1/2021 and were admitted at a tertiary academic hospital. Intra-dialytic hypotension (IDH) was defined as mean arterial pressure (MAP) ≤ 60 millimeter-mercury (mmHg) or a decrease in MAP by ≧ 10 mmHg, systolic blood pressure (SBP) less than or equal to 90 mmHg or a decrease in SBP by ≧ 20 mmHg, or increased vasopressor requirement. These were measured in 15-minute increments and the number of episodes in each hour was recorded. The number of events was analyzed by Poisson regression with repeated-measures analysis of variance using the generalized estimation equation.
Results
There were 669 patients with AKI who required CKRT during the study period. Use of blood warmer on first day of CKRT was in 324 (48%) patients. Patients where a blood warmer was used were more likely to have required vasopressor or inotropes (56% vs 45%, p =0.003), be diagnosed with sepsis/septic shock (81% vs 74%, p=0.04), and were in a less positive fluid balance at the time of CKRT initiation (1.0 vs 1.3 L, p=0.03) compared to patients where a blood warmer was not used. The incident rate ratio for IDH during the first 24 hours of CKRT in patients where a blood warmer was used was 1.06 (95%CI 0.98; 1.13) compared to those where blood warmer was not used. After adjusting for variables that were different between the two groups and clinically relevant ones (norepinephrine equivalents, mechanical ventilation and MAP at time of CRRT initiation and ultrafiltration on CRRT day1), using a blood warmer did not increase IDH episodes. Overall, the within-subject effect of temperature on IDH on first day of CRRT was negative, meaning that higher temperature was associated with fewer IDH (relative risk of 0.94, 95% CI 0.9; 0.99 for each 10 degrees increase, p 0.007).
Conclusion
Blood warming techniques during CKRT were not associated with worsening hemodynamic instability during first day of CKRT.
Funding
- Other NIH Support